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Department of tNe Treasury -Internal Revenue Service
IRev. February 2004) ~ Notice Of Federal Tax uen
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Area: Se lal Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1
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As provided by section 6321, 6322, and 6323 the Internal Revenue
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Code, we are giving a notice that taxes (includht interest and penalties) .
have been assessed agahut the following-named r. We have made
a demand for payment of this liability, but it r ins unpaid. Therefore, '- ~ SS3
there is a lien in favor of the [lnited States on a 1 property and rights to L.lC
property belonging to this taxpayer for the a nt of these taxes, and
addhionai penalties, interest, and costs that
accrue. ~ OZlg 7 to
Name of Taxpayer MARY L THOMAS i
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Residence 52 S HIGH ST
NEWVILLE, PA 17241-14,16
IMPORTANT RELEASE INFORMATION: For ea h assessment listed below,
unless notice of the lien is refiled by the date given in olumn (e), this notice shall,
on the day following such date, operate as a certif cats of release as defined
in IRC 6325(al.
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last D for
Refi~ng Unpaid Balance
of Assessment
(a) (b) c d) e
1040 12/31/2005 XXX-XX-9693 02/11/2008 03/13/2018 11169.53
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Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 11169.53
on this,
This notice was prepared and signed at
the _ 18th day of December 200
IT, MI
Signature ~ A ~>'Zi~~ Title
ACS 11-00-0000
for DEBRA K. HURST (800) 829-7650
(NOTE: Certificate of officer authorized by law to takeacknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(n(c) IRev. 2-2004)
Part 1 -Kept By RtcordinQ OMce rer non ann~~Y