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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) I Notice of Federal Tax Lien
iRev. February 20041
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 .a°d P~/J t`/rj,tr0
Lien Unit Phone: (S00) 913-6050 519446309 '~7
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are gh-ing a notice that taxes (including interest and penalties)
have been assessed a8ainst the following-named taxpayer. We have made
a demand for payment of this IiabYity, but it remains unpaid. Therefore,
there is a Ikn in favor of the united States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
addkional penakies, interest, and costs that may aarue.
Name of Taxpayer
Residence 101 ENOLA DR
ENOLA, PA 17025-2707
GYZ. 33 3v
~ ai~v7
IMPORTAI~IT RELEASE Il11FORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column le), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a1.
Tax Period Date of Last_ Darr for
Kind of Tax Ending Identifying Number Asses~nent g
w
ca
.~ . `°
~
r~'~ ~
,
,
~'_~ .
,~+
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tr ~
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~~"" .c ~~,;
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unpaid Balance
of Assessment
1040 12/31/1996 XXX-XX-9616 04/15/2002 05/15/2012 1201.13
1040 12/31/1997 XXX-XX-9616 03/18/2002 04/17/2012 4520.63
1040 12/31/1998 XXX-XX-9616 03/18/2002 04/17/2012 3342.21
1040 12/31/2003 XXX-XX-9616 03/31/2008 04/30/2018 70944.06
1040 12/31/2004 XXX-XX-9616 03/31/2008 04/30/2018 56932.31
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 136940.34
This notice was prepared and signed at
DETROIT, MI
the 2 3rd day of February 2 0 0 9
on this,
Signature ~ Title
REVENUE OFFICER 22-06-1442
for DAVID M. SHROYER (717) 777-9625 x1320
(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(n(c) (Rev. 2-2004)
Part 1 -Kept Bp R,ecordiDg OfAce CAT. NO 60025X