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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. Februarv 2004) Notice of Federal Tax Lien
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Area: Serial Number For Optional Use y Recording Office
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650
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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 1
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 4 7) r"
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additional penalties, interest, and costs that may accrue.
Name of Taxpayer ROBERT E & SAMANTHA L GRAYBILL
Residence 5235 WINTHROP AVE
MECHANICSBURG, PA 17050-7367 Q
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IMPORNT RELEASE INFORMATION: For each assessment listed below
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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).
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refilling l!M paid Balance
Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2006 XXX-XX-2449 01/05/2009 02/04/2019 7001.03
Place of Filing
Prothonotary
Cumberland County Total $ 7001.03
Carlisle, PA 17013
This notice was prepared and signed at
the 14th day of May
DETROIT, MI
2009
, on this,
Signature Title -
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 6680)(e) (Rev. 2-2004)
Part 1 - Kept By Recording Office . T ., ,