HomeMy WebLinkAbout08-1959Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury -Internal Revenue Service
Notice of Federal Tax Lien
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050
431849708
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As provided by section 6321, 6322, and 6323 of the Internal Revenue
enalties)
interest and
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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,
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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. ~~` oZp/v8'y8
Name of Taxpayer ROBERT H BLACK
Residence 1788 N MEADOW DR
MECHANICSBURG, PA 17055-5152
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 tollowing such date, operate as a certificate of release as defined
in IRC 63251a).
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment RefilMg of Assessment
(a) (b) (c) (d) (e)
6672 12/31/2004 XXX-XX-5571 01/07/2008 02/06/2018 30743.00
6672 03/31/2005 XXX-XX-5571 01/07/2008 02/06/2018 27243.97
6672 06/30/2005 XXX-XX-5571 01/07/2008 02/06/2018 16523.34
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Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $
This notice was prepared and signed at
DETROIT, MI
74510.31
on this,
the 20th day of March 2008
Signature A ~ Title
REVENUE OFFICER 22-06-1408
for MIGNA RODRIGUEZ {717) 777-9622
(NME: 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) Form 668(ln(c) (Rev. 2-2004)
Part 1 • Kept BY Recording OPftce CAT. NO 60025X
11883 Department of the Treasury -Internal Revenue Service
Form bb8 {Z} Certificate of Release of Federal Tax Lien
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Area: Serial Number Far Use by Recordin Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phane: 1800} 913-6050 431849708 ~~~
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I certify that the following-earned taxpayer, under the requirements of section 6325 ta)
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefare, the lien provided by Code section 6321 far these taxes and
additions has been released. The proper officer in the affice where the notice of
internal revenue tax lien was filed on March 28
2 0 0 8 is authorized to Hate the banks to shave the release of this lien for
these taxes and additions.
Name of Taxpayer c~
ROBERT H BLACK ;~ c
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Residence 17 8 8 N MEADOW DR ~ r-- ~ ~. a..~,.£
MECHANICSBURG, PA 17055-5152 -C~ - `°~''
COURT RECORDING INFORMATION: ~'~ -.Q `r` -~
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Liber Page UCC Na. Serial No. ~c rv °~;
n/a n/a n/a 08-1959FTL '~ --~
Tax Period Date of Last Dayy far unpaid Balance
Kind of Tax Ending identifying Number Assessment Refiling of Assessment
(al !b1 (cJ !dJ (el lfl
6672 12/31/2004 XXX-XX-5571 01/07/2008 02/06/2018 30743.00
6672 03/31/2005 XXX-XX-5571 01/07/2408 02/06/2018 27243.97
6672 06/30/2005 XXX-XX-5571 01/07/2008 02j06/2018 16523.34
Place of Fiiing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $ 74 510.31
This natire was prepared and signed at
DETROIT, MI
the 22nd day of September , 2010 ,
Signature
on this,
Title Director, Campus Compliance
Operations
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax liar Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Forrn 668 (Z) iRev. 10-20001
Part t -RECORDING OFFICE CAT. NO 600261