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Department of the Treasury - Internal Revenue Service
Form 668 ( Notice of Federal Tax Lien
(Rev. February 2 2004) 0041
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 668403010
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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 cza
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
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additional penalties, Interest, and costs that may accrue.
Name of Taxpayer WILLIAM J FORSYTH JR , f`
Residence 99 FETROW LN
NEW CUMBERLAND, PA 17070-3042
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
this notice shall,
unless notice of the lien is refiled by the date given in column lel
pU ?Q?
lg
, ,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). _
Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Re filling of Assessment
(a b) c d e f)
1040 12/31/2008 XXX-XX-1607 05/25/2008 06/24/2018 5755.67
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$ 5755.67
This notice was prepared and signed at
DETROIT, MI
the 17th day of June 2010
, on this,
Signature )K? A 'Y r 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)
Part 1 - Kept By Recording Office CAT. 668(1 (Rev. 2-2004)
CAT. NO 60025X
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