HomeMy WebLinkAbout08-1767Form 668 (Y)(c)
(Rev. February 2004)
615
Department of the Treasury -Internal Revenue Service
Notice of Federal Tax Lien .~ ~ ~_ i~ ~ ,~ ~ 7-L
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650
428693308
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AS provided by section 6321, 6322, and 6323 of the Internal Revenue ~
Code, we are giving a notice that taxes (including interest and penalties) ~ ~
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have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, .~ v (• `~ I s
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 t"~ w
additional penalties, interest, and costs that may accrue. -r.~ =;' ~c ~
Name of Taxpayer DAVID M BURNHAM =,` .~,~
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Residence 5 0 0 9 MCDONALD DR APT 3 --11-
MECHANICSBURG, PA 17050-2405 ~;: ;- ._...~
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, ..
unless notice of the lien is refiied 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(x1.
Tau Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) b) (c d) (e) (f)
1040 12/31/2002 XXX-XX-4029 04/09/2007 05/09/2017 3516.77
1040 12/31/2003 XXX-XX-4029 04/09/2007 05/09/2017 3473.15
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 6989.92
This notice was prepared and signed at
the 11th day of March
DETROIT, MI
2008
on this,
Signature ~ y ~/~~ ACS 11-00-0000
for DEBRA K. HURST (800) 829-7650
(NOTE: Certificate of otticer 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) Form 668(lt7(c) (Rev. 2-2004)
Part t -Kept By Recorfieg Office CAT. NO 60025X