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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004)
,
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 575154209
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
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.
Name
Residence 25 E LISBURN RD APT 1
MECHANICSBURG, PA 17055-5899
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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).
Tax Period
Kind of Tax Ending
1040 12/31/1999
1040 12/31/2005
1040 12/31/2006
1040 12/31/2007
Place of Filing
Identifying Number
(c)
XXX-XX-7896
XXX-XX-7896
XXX-XX-7896
XXX-XX-7896
Prothonotary
Cumberland County
Carlisle, PA 17013
For Optional Use by Recording Office
04 - s9sty
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Date of I Last Day for
Assessment Refiling
07/22/2002
04/16/2007
05/28/2007
05/26/2008
08/21/2012
05/16/2017
06/27/2017
06/25/2018
Total 1 $ 6129.43
This notice was prepared and signed at
the 21st day of August
DETROIT, MI
Unpaid Balance
of Assessment
627.54
(-? r..7 2 3 .95
t.. U53R14
-5624
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C_'i
, on this,
2009
Signature A 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