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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 780089811
As provided by section 6321, 6322, and 6323 of the Internal Revenue ?G r 7L
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
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. e?
Name of Taxpayer J GOURLEY o - ----.(
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Residence 3B ROUND RIDGE RD w
MECHANICSBURG, PA 17055-9211 r-= -4'
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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, 71
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). r
Tax Period Date of Last Daryr for Unpa id Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2002 XXX-XX-5777 11/21/2005 12/21/2015 4164.40
1040 12/31/2003 XXX-XX-5777 08/04/2008 09/03/2018 15564.17
1040 12/31/2004 XXX-XX-5777 01/11/2010 02/10/2020 23431.37
1040 12/31/2005 XXX-XX-5777 01/11/2010 02/10/2020 22542.85
1040 12/31/2006 XXX-XX-5777 01/11/2010 02/10/2020 25890.31
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 91593.10
This notice was prepared and signed at
the 26th day of April
DETROIT, MI
2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
(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