HomeMy WebLinkAbout09-5525Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien X /7 1 56a 4- C ri
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
569227809
P 19. 071
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) C, t' 9 9
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, a 8 9 3 _
there is a lien in favor of the United States on all property and rights to c T;
property belonging to this taxpayer for the amount of these taxes, and - ; ?. -_..,
additional penalties, interest, and costs that may accrue.
Name of Taxpayer ANDREW HIESTER SR - -_j =
v _r-
Residence 230 CAMPHILL MALL r<?
CAMP HILL, PA 17011
ASE INFORMATION: For each assessment listed below,
n is refiled by the date given in column (e), this notice shall,
=
such date, operate as a certificate of release as defined
6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Id
entifying Number
Assessment
Refilling
of Assessment
(a) (b) (c) (d) (e) (f)
941 06/30/2001 25-1861587 04/28/2003 05/28/2013 2211.25
941 09/30/2001 25-1861587 04/28/2003 05/28/2013 2985.10
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 5196.35
This notice was prepared and signed at DETROIT, MI
the 30th day of July 2009
, on this,
Signature Yk'? Title
ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
(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 1 -Kept By Recording Office CAT. NO 60025X