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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien G
(Rev. February 2004) ~~, b rJ. (r / Q6 ~ T,.(,.~.,.
Ar Serial Number For Optional Use by Recording Office
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WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650
403351007 ~`/Q ~
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As provided by section 6321, 6322, and 6323 of the Internal Revenue ~ ~~ 5 ~
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~ a o / v o z-
a demand for payment of this liability, but it remains unpaid. Therefore, „
there is a lien in favor of the United States on all property and rights to _ ;
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property belonging to this taxpayer for the amount of these taxes, and ~'° '`
additional penalties, interest, and costs that may accrue. ~ ` ~ ,~„~ rn ~''
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Name of Taxpayer PATRICIA A GROHOL '° `
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Residence 4119 NANTUCKET DR ~ ~ - c.,,~ ~~
MECHANICSBURG, PA 17050-7604 ~ ,~
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refili ng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2004 XXX-XX-2178 02/19/2007 03/21/2017 1659.07
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 16 5 9. 0 7
This notice was prepared and signed at
DETROIT, MI
the 09th day of November 2007
on this,
Signature ~ ~ Title
ACS 11-00-0000
for DEBRA K. HURST (800) 829-7650
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 -Kept BY Recording Office Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X