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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien 'r~ l /-'
(Rev. February 2004) ~ . V ~. ~r .3 (. ~ r' ~L
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2 rd ~,,(J
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Lien Unit Phone: (800) 913-6050 436193108 TT
As provided by section 6321, 6322, and 6323 of the Internal Revenue ~ ~ ~o ~
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 ~ ~ ~ 7 ~ 0
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 s-..
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additional penalties, interest, and costs that may accrue. ,
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Name of Taxpayer ROBERT E JACKSON JR
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Residence 1112 SLATE HILL RD ~ cr "
CAMP HILL, PA 17011-7823
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column 1e1, 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) (~
941 09/30/2007 23-2296489 12/17/2007 01/16/2018
941 09/30/2007 23-2296489 02/04/2008 03/06/2018 2954.18
941 12/31/2007 23-2296489 03/03/2008 04/02/2018 238.33
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $ 3192.51
This notice was prepared and signed at
the 08th day of April
DETROIT, MI
2008
on this,
Signature ~ A ~Yy~ 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) Form 668(ln(c) (Rev. 2-2004)
Part 1 -Kept By Rewrding Office CAT. NO 60025X