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Department of the Treasury - Internal Revenue Service
Form 668 ( Notice of Federal Tax Lien
(Rev. February 2 2004) 004)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 608746409
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 WILLIAM A DELANCEY
Residence 128 LEEDS RD
NEWVILLE, PA 17241-9597
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).
For Optional Use by F
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Tax Period Date of Last Day for
Kind of Tax Ending Identifying Number Assessment Refiling
(a) (b) (c) (d) (e)
1040 12/31/2008 XXX-XX-7100 06/22/2009 07/22/2019
4026.89
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Place of Filing
Prothonotary
Cumberland County Total $ 4026.89
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
Unpaid Balance
of Assessment
, on this,
the 17th day of December 2009
Signature
jk? A '& ATitle
CS 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