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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) 71.6 .d . 3 9,'/
FR-
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1 to / 9 s ? 9 (rQ
Lien Unit Phone: (800) 829-7650 554751109
As provided by section 6321, 6322, and 6323 of the Internal Revenue
54 d y
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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 n
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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 N
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additional penalties, Interest, and costs that may accrue.
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Name of Taxpayer JOSEPH E CONNOLLY :
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Residence 5585 BARBARA DR
MECHANICSBURG, PA 17050-7216
to
NT RELEASE INFORMATION: For each assessment listed below, cn
e of the lien is refiled by the date given in column (e), this notice shall,
7
F
following such date, operate as a certificate of release as defined
1
RC
5(a).
Tax Period Date of Last Day f or Unpaid Balance
Kind of Tax Ending Identifying Number Assessment ReMng of Assessment
a b c d e f)
1040 12/31/2004 XXX-XX-2760 01/07/2008 02/06/2018 14172.14
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 14172.14
This notice was prepared and signed at DETROIT, MI
the 09th day of June 2009
, on this,
Signature ?- f `Y ? 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 668M(c) (Rev. 2-2004)
Part 1 - Kept By RKordhlg Ollfke CAT_ NO ROO25X