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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
[Rev. October 2000)
Area: I Serial Number
WAGE & INVESTMENT AREA #2
Lien Unit Phone: (800) 829-7650 230181725
As provided by section 6321, 6322, and 6323 of the Intenia: Revenue
Code, we are giving a notice that uxes (including interest and penalties)
have been assessed against the following-named Uxpayer. We have made
a demand for payment of this Ilabiiky, but it remains unpaid. Therefore,
there is a lien in favor of the United S~ates on all propeFt7 and Fights to
property belonging to this taxpayer for the amount of these uxes, and
additional penalties, interest, and costs that may accrue.
Notice of Federal Tax Lien
For Optional Use by Recording Office
Name of Taxpayer MATTHEW J KOSTELAC
Residence 20 DEER LN
CARLISLE, PA 17013-9093
Kind of Tax
(a)
1040
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).
Date of
identifying Number Assessment
(c) (d)
173-52-0976 04/10/2000
Last Day for
Reflling
(e)
05/10/2010
Total
Unpaid Balance
of Assessment
I
Tax Period
Ending
(b)
12/31/1997
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
(f)
8148.14
8148.14
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the 02nd day of November , 2001
Signature ,,~_.~ ~ ? ~-n I Title
ACS 23-01-0000
for P S LANE i (800) 829-7650
(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 &&8(¥)(¢) (Rev. 10-00)
Part 1 - Kept By Recording Office CAT. NO 60025X