HomeMy WebLinkAbout04-1564
1008
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
J1.o0<{-/5/PY FTL
(Rev. February 2004)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 829-3903 164277504
As provided by section 632., 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore,
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.
Name of Taxpayer TIMOTHY CLARK & CARLA DENTE CLARK
For Optional Use by Recording Office
lit. P'f!" /'/.#1)
Cle-.. q F; 1
a1.. i'-l9f1f
",
C;"}
C"..::;,
~-
>
'.'
:.:;,'.)
(' "
o
~'n
---I
-,--
hl#
-r,rn
,~CJo
'~,6
~~r,
~':j;n
C~) S-~ ' .n
Residence
9 SAND PINE CT
MECHANICSBURG, PA 17050-8500
w
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien ;s 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 IRe 6325(a).
:7:{
C:)
f',:'
-,-
Kind of Tax
(a)
1040
Tax Period
Ending
(b)
12/31/2002
Identifying Number
(c)
560-85-5346
Date of
Assessment
(d)
09/15/2003
Last Day for
Refiling
(e)
10/15/2013
Unpaid Balance
of Assessment
(f)
23124.78
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
23124.78
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the
24th day of March
2004
Signatu~ ~ I
for ~~.ct);.J
f<
W-f.p"", /I.#7~
Title
ACS
(800)
23-00-0008
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. Ru!' 71-466. 1971 .2 C.B. 409)
Part 1 - Kept By Recording Office
Form 668(Y)(c) IRev. 2-2004)
CAT. NO 60025X
11596 Department of the Treasury - Internal Revenue Service
Form 668 (Z) Certificate of Release of Federal Tax Lien
(Rev. 10-2000)
Area: Seriai Number For Use by Recordina Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 ot{-IS~1f.- F1l- rer
Lien Unit Phone: (800) 913-6050 164277504
I certify that the following-named taxpayer, under the requirements of section 6325 (
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 for these taxes and
additions has been released. The proper officer in the office where the notice of fJ ffj rS- -
internal revenue tax lien was filed on April 13
2004 , is authorized to note the books to show the release of this lien for
these taxes and additions.
Name of Taxpayer C-- 5JJ.j
TIMOTHY CLARK & CARLA DENTE CLARK { 1~7~
Residence 9 SAND PINE CT
MECHANICSBURG, PA 17050-8500
eOURT RECORDING INFORMATION:
Liber Page uee No. Serial No.
n/a n/a n/a 04-1564-FTL
Tax Period Date of Last D'1f. for Unpal4-Pala~e
Kind of Tax Ending Identifying Number Assessment Refi mg ~'Im ~
(a) (b) (e) (d) (e)
1040 12/31/2002 560-85-5346 09/15/2003 10/15/2013 i~\ ~124~8
******** **********'iI ************* *********** ************ ** '/i!Ji,***~** **
Z'\:;, cP
co ...'"." ' :=-\
2': cr.~
ccc... ..., b
~c :::!It %
~o c..'l 9
c: .- ';P.;
~ ~ ~
place of Filing
Prothonotary
Cumberland County Total $ 23124.78
Carlisle, PA 17013
M.
../
,)"0
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the
30th day of July
2005
Signature
Title Director, Payment Compliance
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax lien Rev. Ruf. 71-466, 1971 - 2 C.B. 409/
Part 1 - RECORDING OFFICE
Form 668 (Z) (Rev. 10-20001
CAT, NO 600261