HomeMy WebLinkAbout09-8258Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien y? o q F.? -5'1 FT i--
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 7'd
7
Lien Unit Phone: (800) 829-3903 600665409 i
As provided by section 6321, 6322, and 6323 of the Internal Revenue "L vs-o?-
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
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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 N
additional penalties, interest, and costs that may accrue.
4Y) 1 )
Name of Taxpayer DAVID J BURGESS CD -
E 3C
Residence 3 524 SEPTEMBER DR APT 2
CAMP HILL, PA 17011-5062
_5
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 Date of Last Day 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-4851 11/17/2008 12/17/2018 10760.62
1040 12/31/2003 XXX-XX-4851 11/17/2008 12/17/2018 9147.84
1040 12/31/2004 XXX-XX-4851 11/17/2008 12/17/2018 11070.12
1040 12/31/2006 XXX-XX-4851 11/17/2008 12/17/2018 4121.93
1040 12/31/2007 XXX-XX-4851 11/17/2008 12/17/2018 1702.16
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 36802.67
This notice was prepared and signed at
the 20th day of November
DETROIT, MI
2009
, on this,
Signature y yh,tF Title
ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
tNOTE: 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 I -Kept By Recording Office CAT. NO 60025X