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I:orm 668 (Y)(c)
(Rev. February 2004)
Area: Serial Number
WAGE & INVESTMENT AREA #2
Lien Unit Phone: (800) 829-7650 173358404
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice Chat 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 Jn 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 cosu that may accrue.
Name of Taxpayer LISA S COLLINS
Residence
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
For Optional Use by Recording Office
185 FAIRVIEW RD
SHIPPENSBURG, PA 17257-9728
IMPORTANT RELEASE INFORIqATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shaH,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying I~lumber Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2000 213-02-5028 08/04/2003 09/03/2013 20826.96
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 20826.96
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 19th day of May 2004
%re :.4.jT..~C~j Title
Signa
re
': '~'/' f~) /~./ ACS 12-00-0000
fo ~' 'L~E-; (800) 829-7650
(~OTE: 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)
Pa~ 1 - Kept B~ R~eording O~e~ Form ~$8(Y)(e) {Rev. 2-2004)
CAT. NO 60025X