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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
IRev. February 20041 Notice Of Federal Tax Lien .~ " o f_ 7 y ~ 5 ~ TL
Area: Serial Number For Optional use by Recordin Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 ~I~ ~, /~ rr/Q (f0
Lien Unit Phone: (800) 829-3903 500940008 "`'fl
As provided by section 6321, 6322, and 6323 of the Internal Revenue ~- ~~ ~ °
Code, we are giving a notice that taxes (including interest and penakies) ~ ~~ Y ~ p,~
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 cn
property belonging to this taxpayer for the amount of these taxes, and ~ ~'+
addhional penalties, interest, and costs that may accrue. _l C..
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Name of Taxpayer DIANNA S DIVELY ~
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Residence 199 GRAIN DR _
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CARLISLE, PA 17013-4614
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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).
Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi~g of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2005 XXX-XX-9201 03/05/2007 04/04/2017 12050.51
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $
12050.51
This notice was prepared and signed at DETROIT, MI
the 11th day of December 2008
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Signature R Title
ACS 22-00-0008
for MICHAEL W. COX (.800) 829-3903
on this,
(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(1()(c) (Rev. 2-2004)
Part 1 -Kept BY Recording Office CAT. NO 60025X