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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 20041 Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1
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Lien Unit Phone: (800) 829-7650 814361511
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
a demand for payment of this liability, but it remains unpaid. Therefore = (-
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there is a lien in favor of the United States on all property and rights to Co o
property belonging to this taxpayer for the amount of these taxes, and rn
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additional penalties, interest, and costs that may accrue. rl +
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Name of Taxpayer CAMILLE C HARRY
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Residence 129 TIMBER LN F r ,° 00
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SHIPPENSBURG, PA 17257-9539 -"
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (a), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). A -f4 96f tlf 4'
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last D for
Refilling Unpaid Balance
of Assessment
(a) (b) (c (d) (e) (f)
1040 12/31/2005 XXX-XX-0632 08/04/2008 09/03/2018 112102.54
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 112102.54
This notice was prepared and signed at
DETROIT, MI
the 14th day of September 2011
, on this,
Signature Title
ACS W&I 11-00-0000
for DEBRA K. HURST (800) 829-7650
(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 I - Kept By Recording Office CAT. 668( (Rev. 2 2004)
CAT. NO 60025X