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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
Notice Of Federal Tax Lien
(Rev. February 2004) n(,. oP- Gss~ F r~
Area: Serial Number For Optional Use by Recording Office __
WAGE & INVESTMENT AREA #1
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Lien Unit Phone: (800) 829-7650 486760308 ,
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As provided by section 6321, 6322, and 6323 of the Internal Revenue ~~ a G y2.F
Code, we are giving a notice that taxes (including interest and penaltks)
have been assessed against the folbwing-named taxpayer. We have made ~J ~ ~ ` 7(, G
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a demand for payment of this Eability, but it remains unpaid. Therefore,
there is a (ien in favor of the united States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
addkional penalties, interest, and costs that may accrue.
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Name of Taxpayer RICHARD L CARBERRY ?~~~F` --t
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Residence
29 N 33RD ST ~:~ -'c`;
CAMP HILL, PA 17011-2702 - .-~,.~
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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unless notice of the lien is' refiled by the date given in column (e1, this notice shall, ~
on the day following `such date, operate as a certrficate of release as defined
in IRC t3325(a).
Tax Period Date of Last ppa~yy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
1040 12/31/2002 XXX-XX-1570 12/04/2006 01/03/2017
Place of Filing
Prothonotary
Cumberland County Total $ .5584.97
Carlisle, PA 17013
This notice was prepared and signed at
the 28th day of October
DETROIT, MI
2008
Signature {~' y `
for DEBRA K. HURST
Title
ACS
(800) 829-7650
5584.97
on this,
11-00-0000
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax ren
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(lf)(c) (Rev. 2-2004)
Part 1 -Kept sY Recording Office CAT. NO 60025X