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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice Of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSII3ESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
497420108
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As provided by section b321, b322, and 6323 of the Internal Revenue C.~2.. ~ ~ 3 ~
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~ 1 r ~' %~ ~ 4
a demand for payment of this liability, but it remains unpaid. Therefore,
there is a lien in favor of the united States on all properly and rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. ~ ~ O
Name of Taxpayer THEODORE R & HEIDI JO WILLIAMS ~'i~' rn
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Residence
12 BRIAR LN '-.`" ,
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CAMP HILL, PA 17011-7903 ~'~ _ ~ ~~
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, ~„~ c,.~
unless notice of the lien is refiled by the date given in column (e), this notice shall, v1
on the day following such date, operate as a certificate of release as defined
in IRC 6325fa).
Tax Period Date of Last Dar~rr for Unpaid Balance
Kind of Tax Ending Identifying Dumber Assessment Refiling of Assessment
(a) (b) (c) (d) (e) f)
1040 12/31/2005 XXX-XX-7587 04/15/2006 05/15/2016
1040 12/31/2005 XXX-XX-7587 04/28/2008 05/28/2018 5275.69
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 5275.69
This notice was prepared and signed at DETROIT, MI
on this,
the 26th day of November 2008
Signature ~ ~ i~y~~1 Title
ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
(NOTE: Certificate of officer authorized by law to tmke acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part t -Kept SY Recordin8 Office Form 668(lf)(c) lRev. 2-2004!
CAT. NO 60025X
11883 Department of the Treasury - Internal Revenue Service
Form 668 (Z) Certificate of Release of Federal Tax Lien
(Rev. 10-2000) Area: Serial Number For Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
1
6050
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497420108 G
one: (800) 9
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I certify that the following-named taxpayer, under the requirements of section 6325 (a)
of the Internal Revenue Code has satisfied the taxes listed below and all statutory a;
additions. Therefore, the lien provided by Code section 6321 for these taxes and
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additions has been released. The proper officer in the office where the notice of l `
internal revenue tax lien was filed on December 09 k
?r7 x=-
2008 , is authorized to note the books to show the release of this lien for M
these taxes and additions. -A- cc)
Name of Taxpayer r'1
THEODORE R & HEIDI JO WILLIAMS
Residence 12 BRIAR LN
CAMP HILL, PA 17011-7903
COURT RECORDING INFORMATION:
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Liber Page UCC No. Serial No. Gt
g.?(? C????
n/a n/a n/a 08-7198FTL 0SS,4'*
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (fl
1040 12/31/2005 XXX-XX-7587 04/15/2006 05/15/2016
1040 12/31/2005 XXX-XX-7587 04/28/2008 05/28/2018 5275.69
******** ********** ************* ********** ************ ****************
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 5275.69
This notice was prepared and signed at
DETROIT, MI
, on this,
the 16th day of February , 2 011
Signature
Title Director, Campus Compliance
Operations
(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. Rul. 71-466, 1971 - 2 C.B. 409) Form 668 (Z) (Rev. 10-2000)
Part 1 - RECORDING OFFICE CAT. NO 600261