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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) nti, U 9- 7S3-Z' T L
A Serial Number For Optional Use by Recording Office
rea:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
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As provided by section 6321, 6322, and 6323 of the Internal Revenue L y g
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made 3 a P/G
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 N
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additional penalties, interest, and costs that may accrue.
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Name of Taxpayer JEFFREY VANBOSKIRK J
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Residence 105 S MARKET ST # 2ND-FL 3MB
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MECHANICSBURG, PA 17055-6328 oX M
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,
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on the following su ch date, operate as a certificate of release as defined
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in IRC 5(a).
Tax Period Date of Last Daar?rr for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Reflling of Assessment
(a) (b (c) (d) e) (f)
940 12/31/1999 25-1635529 08/21/2000 09/20/2010 255.34
941 09/30/1999 25-1635529 01/03/2000 02/02/2010 10977.12
941 12/31/1999 25-1635529 08/28/2000 09/27/2010 20960.94
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 32193.40
This notice was prepared and signed at
the 22nd day of October
DETROIT, MI
2009
, on this,
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)
Port 1 - Kept By Retordin8 ice t;A+; idl?