HomeMy WebLinkAbout04-1630Form 668 (Y)(c)
(Rev. February 2004)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 829-3903 166417204
As provided by section 6321, 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 liabiliw, but it remains unpaid. Therefore,
there is a lien in favor of the United States on all properW and rights to
properW belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue,
Name of Taxpayer DOUGLAS E PETERS
1008
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
For Optional Use by Recording Office
ck. '7
-1-
Residence
149 S ENOLA DR
ENOLA, PA 17025-2712
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),
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Reflllng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2001 208-52-4633 11/11/2002 12/11/2012 5033 .65
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 5033.65
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 06th day of April 2004
Signa{'t~2 Title
f O r ¢2~ I~~ /~. ~ ~__~¢¢~ ACS 23-00-0008
(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)
Form 668(¥)(¢) (Rev, 2-2004)
Part I -Kepc By Recording Office CAT. NO 60025X