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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Notice Of Federal Tax Lien
lRev. February 2004) ~'f,, G ~. lyo2 y ~T1_
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2 /I~~Q
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7 Y ~`~9.ut~
Lien Unit Phone: (800) 913-6050 423858108 .
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As provided by section 632 t, 6322, and 6323 of the Internal Revenue C12.. ~ L
Code, we are giving a notice that taxes (including interest and penalties) ~ ao,sG3~
have been assessed against the following-named taxpayer. We have made ~ ~ r.~
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 r~ ~~~ r
additional penalties, interest, and costs that may accrue. a corporation _I ?"; ~;
r ~
Name of Taxpayer MOUNTAIN LAKES FARM MARKET INC .,..,-! `,r
`- ca . ~ r~7~i
Residence 298 MCALLISTER CHURCH RD .. .:-t
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CARLISLE, PA 17015-9504 ~''` ~'
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 Refiling of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/2004 25-1757255 10/01/2007 10/31/2017 1363.03
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 13 6 3. 0 3
This notice was prepared and signed at DETROIT, MI
the 22nd day of February 2008
on this,
Signature ~ ~ \Yti~~ Title
REVENUE OFFICER 22-06-1450
for JEFFREY WHITE (717) 777-9623 x1300
(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 ~ Recordin Office Form 668(Y)(c) (Rev. 2-20041
S CAT. NO 60025X