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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 575653509
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 of Taxpayer EUGENE N & LORRAINE G BENNETT
Residence 703 ERFORD RD
CAMP HILL, PA 17011-1126
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 63251a?.
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2002 XXX-XX-5055 05/01/2006 05/31/2016 3865.10
1040 12/31/2003 XXX-XX-5055 02/26/2007 03/28/2017 5758.39
For Optional Use by Recording Office
OQ - 4.61,3 j14.G6 ?'L-?I?E
CK-a 5.73
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61
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Place of Filing
Total 1$ 9623.49
Prothonotary
Cumberland County
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI
the 25th day of August , 2009
, on this,
Signature H ACS
22-00-0008
for MICHAEL W. COX (800) 829-3903
(ROTE: 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