HomeMy WebLinkAbout09-2915Department of the Treasury - Internal Revenue Service
Form 668 ( Notice of Federal Tax Lien t) 02 --1 ? FT j
Fehruary 2 2004) 004) /,S- ?J ?
Area: Serial Number
WAGE & INVESTMENT AREA #1
Hen Unit Phone: (800) 829-7650 542572709
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties)
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
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer WILLIAM E SAMPSON
Residence PO BOX 632
CARLISLE, PA 17013-0632
For Optional Use by R<
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Unpaid Balance
of Assessment
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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 Day for
Kind of Tax Ending Identifying Number Assessment Refiling
(a) (b) (c) (d) (e)
1040 112/31/20031 XXX-XX-9897 112/18/20061 02/06/200603/07/2016
1040 12/31/2004 XXX-XX-9897 01/17/2017
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
1920.83
3141.08
Total 1 $ 5061.91
This notice was prepared and signed at DETROIT, MI
the 01st day of May 2009
, on this,
Signature Title
A. ACS 11-00-0000
for DEBRA K. HURST (800) 829-7650
(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(Y)(c) (Rev. 2-2004)
Part I - Kept By Recording Office (`AT rvn F0n9Sx