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Department of the Treasury - Internal Revenue Service
Form 668 (~)(,) Notice of Federal Tax Lien
(Rev. October 2000)
Area: { Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
lien Unit Phone: (800) 829-3903 142033403
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
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
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer $~ND¥ S OLSEN
59 REGENCY WOODS N APT 3
CARLISLE, PA 17013-9064
Residence
II~IPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is reft)ed by the date given in column (el, this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax PeHod Date of Last Day for
Kind of Tax Ending Identifying Number Assessment Refi~ng
(al (b) (c) (al (el
1040 12/31/2000 208-38-5062 05/14/2001 06/13/2011
1040 12/31/2001 208-38-5062 06/03/2002 07/03/2012
1040 12/31/2002 208-38-5062 05/19/2003 06/18/2013
For Optional Use by Recording Office
Unpaid Balance
of Assessment
(fl
290.15
192.79
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 1637.25
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 04th day of November 2003
for L LEDER
Title
ACS
(800)
829-3903
23-00-0008
(l~lOTlC: Certificate of officer authorized by law to take acknowJedgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(¢) (Rev. 10-00)
Par~ I - Kep~ By Recording O~flce CAT. NO 60025X