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I Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) ikr_At__ _,c t
(Rev. February 2004) ¦wiN%,4W v¦ ¦ WWAWN w¦ ¦ UAW NOWWRE F n
Area: Serial Number For Optional Use b j Recording Office
WAGE & INVESTMENT AREA #1 '1
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Lien Unit Phone: (800) 829-7650 548156409 t
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As provided by section 6321, 6322, and 6323 of the Internal Revenue 3 Y5
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Code, we are giving a notice that taxes (including interest and penalties) _
have been assessed against the following-named taxpayer. We have made S'GG t j
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 r,
additional penalties, interest, and costs that may accrue.
Name of Taxpayer ROBERT E GRAYBILL JR
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Residence 5235 WINTHROP AVE j
MECHANICSBURG, PA 17050-7367
NT RELEASE !INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
F
following such date, operate as a certificate of release as defined
IRC
5(a).
Tax Period Date of Last Day f or >tpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling f Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2007 XXX-XX-2449 05/26/2008 06/25/2018 2626.73
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Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total I$ I 2626.73
This notice was prepared and signed at
the _ 14th day of May
DETROIT, MI
2009
, on this,
Signature ATitle
CS li 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 Notid of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) o2.t t - Kant Rv Recordinv Offire Form 8(Y)(0 (Revc 2 2004)