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Department of the Treasury - Internal Revenue Service
Form 666 MW
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
659574610
419.00 PQ I?L1=F
As provided by section 6321, 6322, and 6323 of the Internal Revenue C ! 0-No
Code, we are giving a notice that taxes (including interest and penalties) ?'? a yag3']
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 d _
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. c
rn?
Name of Taxpayer RONALD D SMITH
?f
Residence
519 W MAIN ST
MECHANICSBURG, PA 17055-3244
C3
RTANT RELEASE INFORMATION: For each assessment listed below,
notice of the lien is refiled by the date given in column (e), this notice shall,
F
e day following such date, operate as a certificate of release as defined
6325(a).
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2003 XXX-XX-7305 05/24/2004 06/23/2014 243.54
1040 12/31/2004 XXX-XX-7305 05/23/2005 06/22/2015
1040 12/31/2004 XXX-XX-7305 01/08/2007 02/07/2017 1388.94
1040 12/31/2005 XXX-XX-7305 10/06/2008 11/05/2018 5658.75
1040 12/31/2006 XXX-XX-7305 10/13/2008 11/12/2018 3694.77
1040 12/31/2007
1 XXX-XX-7305 09/29/2008 10/29/2018 249.64
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 11235.64
This notice was prepared and signed at DETROIT, MI
the 25th day of May 2010
, on this,
Signature Title
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)
Part 1 - Kept By Recording Office CAT. NO 60025X