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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev, February 2004)
Notice of Federal Tax Lien
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 829-3903
Serial Number
186498204
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that ~axes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but Jt remains unpaid. Therefore,
there is a lien in favoF of the United States on ail property and Fights tO
property belonging to this uxpayer for the amount of these taxes, and
additional penalties, Interest, and costs that may accrue.
Name of Taxpayer FRED C MILLER
Residence
PO BOX 3263
SHIREMANSTOWN, PA 17011-3263
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
I in IRC 6325(a).
Tax Period
Kind of Tax Ending
(a) (b)
12/31/2002
12/31/2003
1040
1040
Identifying Number
(c)
196-48-2678
196-48-2678
Date of
Assessment
(d)
05/26/2003
06/07/2004
Prothonotary
Cumberland County
Carlisle, PA 17013
For Optional Use by Recording Office
¢_/.c //at i::~:
Last Day for
Refiling
(e)
06/25/2013
07/07/2014
Unpaid Balance
of Assessment
(f)
Place of Filing
4219.95
4707.36
Total 8927.31
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 12th day of August 2004
23-00-0008
,fignature
Title
ACS
(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) Form 668(Y)(c) (Rev. 2-2004)
Part I - Kept By Recording Office CAT. NO 60025X
Form 668 (Z)
(Rev. 10-2000)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (412) 395-5265 186498204
I certify that the following-named taxpayer, under the requirements of section 6325 (a)
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 for these taxes and
additions has been released. The proper officer in the office where the notice of
internal revenue tax lien was filed on August 25
2004 , is authorized to note the books to show the release of this lien for
these taxes and additions,
Name of Taxpayer
FRED C MILLER
? 954 Department of the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
Residence PO BOX 3263
SHIREMANSTOWN, PA 17011-3263
COURT RECORDING INFORMATION:
Liber Page UCC No. Serial No.
n/a n/a n/a 04-4246 FTL
For Use by Recording Office
0-;'---. 97L.
~__.~... 15£ 700
Tax Period Date of Last Da~ for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refihng of Assessment
(a) (b) (c) (d) (e) If)
1040 12/31/2002 196-48-2678 05/26/2003 06/25/2013 4219.95
1040 12/31/2003 196-48-2678 06/07/2004 07/07/2014 4707.36
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 8927.31
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 13th dayof December , 2004.
Signature /~~.X~ . Title Director, Payment Compliance
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax lien Rev. Rul. 71-466, 1971 - 2 C.B, 409) Form 6&8 (Z) (Rev. 10-2000)
Part ! - RECORDING OFFICE CAT. NO 600261