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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Notice Of Federal Tax Li
(Rev. February 2004) D8. S9 g F TL
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
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Lien Unit Phone: (800) 829-3903 458399508 r
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As provided by section 632 t, 6322, and 6323 of the Internal Revenue ~1e.. ~ ~ ~ ~ P
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~ a /a yJl
a demand for paj-ment of this liability, but it remains unpaid. Therefore, ~ rv
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 , ;-, _ ~-..
additional penalties, interest, and costs that may accrue. - ~=== i',~T?
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Name of Taxpayer JOHN DRUSCHEL -- ,, ;~~
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Residence 3 9 01 CHESTNUT ST - ~, ~- ; r~`r~~
CAMP HILL, PA 17011-4214 `~:' c.n `z~
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column le), 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 Daayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) d) a (f)
1040 12/31/2003 XXX-XX-2001 07/10/2006 08/09/2016 13883.94
1040 12/31/2003 XXX-XX-2001 07/10/2006 08/09/2016
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 13883.94
This notice was prepared and signed at
the 22nd. day of July
DETROIT, MI
2008
on this,
Signature ~ A ~/y~~ ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
(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 BY Recording Ofiice Form 668(1()(c) (Rev. 2-2004)
CAT. NO 60025X