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4805 Department of the Treasury -Internal Revenue Service
Form 668 (Z) Certificate of Release of Federal Tax Lien
cRev. io-2oo0-
Area: Serial Number For Use b Recording Office
WAGE & INVESTMENT AREA #1 ~
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Lien Unit Phone: (800) 913-6050 238712144 ~
I certify that the following-named taxpayer, under the requirements of section 6325 la1 ~ ~ ~ ~
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 for these taxes and p _ ~ ;~ p
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additions has been released. The proper officer in the office where the notice of o~-
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internal revenue tax lien was filed on November 04 ~ ~ ~
1987 is authorized to note the books to show the release of this lien for ;~~'. ~*t
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these taxes and additions. - `~ t~~^
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Name of Taxpayer ,, r =~'~
THEODORE S WEAVER JR ~
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Residence 4611 A FLORENCE AVE ~ „~
MECHANICSBURG, PA 17055 t~
COURT RECORDING INFORMATION:
Liber Page UCC No. Serial No
}
n/a n/a n/a 4561 /
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending identifying Alumiber Assessment R of Assessment
a b c d q
1040 12/31/1984 XXX-XX-1916 08/12/1985 09/11/1991 2434.11
1040 12/31/1985 XXX-XX-1916 06/02/1986 07/02/1992 3604.62
1040 12/31/1986 XXX-XX-1916 05/25/1987 06/24/1993 5494.68
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $ 115 3 3 .41
This notice was prepared and signed at
Philadelphia, PA
the O 1st day of February ~ 2 0 0 9 ,
Signature
on this,
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