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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien FrL-
A Serial Number For Optional Use by Recording Office
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SMALL BUSINESS/SELF EMPLOYED AREA #2 tr/ClfJO
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Lien Unit Phone: (800) 829-3903 569652809 r
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As provided by section 6321, 6322, and 6323 of the Internal Revenue CK ` 79
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.
7-11 M
Name of Taxpayer RONALD L II & KIMBERLY M CONAWAY
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Residence 5 LOCUST CIR
MECHANICSBURG, PA 17050-3131
NT RELEASE INFORMATION: For each assessment listed below,
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unless e of the lien is refiled by the date given in column (e), this notice shall,
:
on the following such date, operate as a certificate of release as defined
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in IRC 5(a).
Tax Per iod Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2002 XXX-XX-0686 08/11/2008 09/10/2018 2059.70
1040 12/31/2003 XXX-XX-0686 08/06/2007 09/05/2017 6768.06
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 8827.76
This notice was prepared and signed at DETROIT, MI
the 31st day of July 2009
, on this,
Signature A 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)
Part 1 - Kept By Recording Office CAT. 668(lr (Rev. 220
CAT. NO 60025X
X