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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(Rev. February 2004) Notice of Federal Tax Lien 1n _ u Qti t:n
Area: Serial Number For Optional Use'by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 654227210 $ 14.00 PO PLFF
As provided by section 6321, 6322, and 6323 of the Internal Revenue Ce WD ales
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 n
property belonging to this taxpayer for the amount of these taxes, and c C= '
additional penalties, interest, and costs that may accrue. -17
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T
Name of Taxpayer JACKSON MECHANICALS INC, a Corporation
Residence 29 RADAM ST
ENOLA, PA 17025-2169 sv
r...
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
o
RC
i
n I 5(a).
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refiling U npaid Balance
of Assessment
(a) (b) (c) (d) (e) M
941 03/31/2009 25-1786422 02/15/2010 03/16/2020 8556.16
941 06/30/2009 25-1786422 02/15/2010 03/16/2020 46080.23
941 09/30/2009 25-1786422 02/08/2010 03/09/2020 70654.75
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 12 52 91.14
This notice was prepared and signed at
the 10th day of May
DETROIT, MI
2010
, on this,
Signature Title
REVENUE OFFICER 22-06-1408
for MIGNA RODRIGUEZ (717) 777-9622
(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 2 - Internal Revenue Service TDA Copy CAT. NO 60025X