HomeMy WebLinkAbout08-6240Form 668 (Y)(c)
(Rev. February 2004)
4
Department of the Treasury -Internal Revenue Service
Notice of Federal Tax Lien h„ n Q - ~ .~ ~~ F rt,
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800} 829-7650
481121308
i"~-. ~~ ~ ~g~~
As Provided by section 6321, 6322, and 6323 of the Internal Revenue ~ pia y ~
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~ 1 i ~* ~~ Y
a demand for payment of this liability, but it remains unpaid. Therefore, ~ ~
there is a lien in favor of the lJnited States on ap property and rights to
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Property belonging to this taxpayer for the amount of these taxes, and ~ ~•? ° ~
additional penalties, interest, and costs that may accrue. ~, ~~ . --} ~
Name of Taxpayer PHYLLIS A CLARK-COLLINS ~' '` o -~~
Residence 319 CHARLES RD ~~-= ~ -~-irn
MECHANICSBURG, PA 17050-3004 ~ ~
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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 (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Dayy for
Refiling unpaid Balance
of Assessment
(a (b) (c) (d) (e) (~
1040 12/31/2003 XXX-XX-7192 12/12/2005 01/11/2016 6132.86
1040 12/31/2004 XXX-XX-7192 12/05/2005 01/04/2016 5915.77
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 12048.63
This notice was prepared and signed at DETROIT, MI
the 09th day of October 2008
on this,
Signature ~ y ~~~,~~ Title --
ACS 11-00-0000
for DEBRA K. HURST (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 668(Y)(c) (Rev. 2-2004)
Part 1 -Kept By Recordieg Oflfice CAT. NO 60025X