HomeMy WebLinkAbout08-7538 3477 -
Department of'the Treasury -Internal Revenue Service
Form 668 (Y)(c)
NOtic~ Of Federal Tax Lien
(Rev. February 2004)
Area: S rial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 ii
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As provided by section 6321, 6322, and 632 of the Internal Revenue
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Code, we are giving a notice that taxes (includi g interest and penakks) t
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have been assessed against the following-mimed taxpayer. We have made
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a demand for payment of this liability, but it r mains unpakl. Therefore, .
there is a lien in favor of the linked States on 11 property and rights to
property belonging to this taxpayer for the a amt of these taxes, and ~ a~BQ~~
additional penakies, interest, and costs that accrue.
Name of Taxpayer BARYON W SHIVELY
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Residence 421 W KELLER ST
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MECHANICSBURG, PA 1755-3732
IMPORTANT RELEASE INFORMATION: For e~ch assessment listed below,
unless notice of the lien is refiled by the date given irk 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 Numb~r Assessment _
g of Assessment
(a) (b c (d) (e) (f)
1040 12/31/2004 XXX-XX-4787! 02/25/2008 03/27/2018 800.74
1040 12/31/2005 XXX-XX-4787', 02/25/2008 03/27/2018 5852.93
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Place of Filing
Prothonotary
Cumberland County ~~~ Total $ 6653.67
Carlisle, PA 17013'
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This notice was prepared and signed at ~I MI , on this,
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the 17th day of December 2008
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Signature A i Title - -
ACS 22 00 0008
for MICHAEL W. COX (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)
Part t - lQept ~ Recording 019f1ce Form 668(ln(c) (Rev. 2-2004)
rer un ann~~Y