HomeMy WebLinkAbout10-6671Form 668 MW
(Rev. February 2004)
11883
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650 709398610
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 followinrnamed 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
ER
Residence 813 FAIRFIELD ST
MECHANICSBURG, PA 17055-4021
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
For Optional Use by Recording Office
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I Tax Period i I Date of I Last Dayy for
Kind of Tax Ending Identifying Number Assessment Refilling
1040 12/31/2002 XXX-XX-0818 111/08/2004:1 12/08/2014
1040 112/31/20041 XXX-XX-0818 03/24/200804/23/2018
Place of Filing
301.99
6360.34
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$ 6662.33
This notice was prepared and signed at
the 12th day of October
DETROIT, MI
2010
, on this,
Signature
11-00-0000
yl? H ACS tle
for DEBRA K. HURST (800) 829-7650
Unpaid Balance
of Assessment
(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