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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) 1D -,1433 F'TL
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 640126610 00 PO ftFF
$14
.
As provided by section 6321, 6322, and 6323 of the Internal Revenue Ale Q'714
Code, we are giving a notice that taxes (including interest and penalties) e?# 2q 0 385
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 JEFFREY A LINE w
z,y
Residence 11 TOPVIEW DR
CARLISLE, PA 17015-9532
NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
F
following such date, operate as a certificate of release as defined
IRC
5(a). i
Tax Period Date of Last D fo r Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refili ng of Assessment
a) (b) (c) (d) (e)
1040 12/31/2003 XXX-XX-8349 06/07/2004 07/07/2014 2293.07
i
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 2293.07
This notice was prepared and signed at DETROIT, MI , on this,
the 01st day of April 2010
Signature y?y Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office
of Notice of Federal Tax lien
Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X
11883 Department of the Treasury - Internal Revenue Service
Form 668 (Z)
(Rev. 10-2000) Certificate of Release of Federal Tax Lien
Serial Number For Use b Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 640126610
1 certify that the following-named taxpayer, under the requirements of section 6325 (a)
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 for these taxes and c-) n .
c C=
additions has been released. The proper officer in the office where the notice of C
internal revenue tax lien was filed on April 13 and
2010 , is authorized to note the books to show the release of this lien for Z? .C 't7rn
these taxes and additions. CO) 4CD
Name of Taxpayer {"" -st
JEFFREY A LINE
On
=:C:)
f- co -4m
Residence ll TOPVIEW DR
CARLISLE, PA 17015-9532
COURT RECORDING INFORMATION :
Liber Page UCC No. Serial No. ?o(
n/a n/a n/a 10-2433 FTL JI-1 o??/ 3
Tax Period Date of Last Davy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Reuling of Assessment
(a) W (c) (d) (6) (f)
1040 12/31/2003 XXX-XX-8349 06/07/2004 07/07/2014 2293.07
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 2293.07
This notice was prepared and signed at
the 10th day of November
Signature
DETROIT, MI
2010
, on this,
Title Director, Campus Compliance
Operations
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax lien Rev. Rul. 71-466, 1971 - 2 C.B. 409) f=orm 668 (Z) (Rev. 10-2000)
Part 1I - RECORDING OFFICE CAT. NO 600261