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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004)
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 707202010 149 _ !/a ?L
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As provided by section 6321, 6322, and 6323 of the Internal Revenue ,D
Code, we are giving a notice that taxes (including interest and penalties) -n
have been assessed against the following-named taxpayer. We have made w 3 Q =-
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a demand for payment of this liability, but it remains unpaid. Therefore, m ca
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there Is a lien In favor of the united States on all property and rights to -?
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property belonging to this taxpayer for the amount of these taxes, and w o
additional penalties, interest, and costs that may accrue. C:1
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Name of Taxpayer PRO-JAK INC, a Corporation c3
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Residence 398 N YORK ST r-
MECHANICSBURG, PA 17055-6260
below,
PORTANT RELEASE INFORMATION: For each assessment listed
:
less notice of the lien is refiled by the date given in column (e), this noticll,
the day following such date, operate as a certificate of release as ed
[
/g-oD pad.
IRC 6325(a).
in
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
941 03/31/2010 25-1685279 09/20/2010 10/20/2020 24708.77
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$ 24708.77
This notice was prepared and signed at
the 05th day of October
DETROIT, MI
2010
, on this,
Signature R. Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
71
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(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