HomeMy WebLinkAbout04-4741Form 668 (Y)(c)
{Rev. February 2004)
Area: Seria~ Number
SMALL BUSINESS/SELF EMPLOYED AREA ~3
Lien Unit Phone: (800) 829-3903 190505604
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,
there is a lien in favor of the United States on ali 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 JOSEPIq T GEMBUSIA
Residence
1872
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
For Optional Use by Recording Office
3510 RAINTREE LN
MECHANICSBURG, PA 17055-2259
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).
Tax PeHod Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Reflling of Assessment
la) lb) lc) (d) (e) (f)
CIVP 06/30/2003 173-36-8376 05/24/2004 06/23/2014 4122.72
CIVP 09/30/2003 173-36-8376 05/24/2004 06/23/2014 3533.76
CIVP 12/31/2003 173-36-8376 05/24/2004 06/23/2014 4122.72
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 11779.20
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 07th_dayof September, 2004
Signat~j~7 ' I Title
ACS 23-00-0008
(]qOTE: Certificate of officer authorized by taw to take acknowledgment is not essential to the validity of Notice of Federal Tax [ien
Form &&8(Y)(¢) (Rev~ 2-2004)
Par~ I - Kept By Recording Office CAT. NO 60025X
Form 668 (Z) 5226 Department of the Treasury - Internal Revenue Service
(Rev. 10-2000) Certificate of Release of Federal Tax Lien
Area: Serial Number For Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050
190505604
ve.Dd I /
?
- ? ,",
1 certify that the following-named taxpayer, under the requirements of section 6325 (a)
f jZ 'AL- .2s
?? 16
o
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 September 21
2004 , is authorized to note the books to show the release of this lien for
these taxes and additions.
Name of Taxpayer C g
JOSEPH T GEMBUSIA
-Orn
Residence 3 510 RAINTREE LN -cn
MECHANICSBURG, PA 17055-2259 C Z
C')
COURT RECORDING INFORMATION: 47
Liber Page UCC No. Serial No.
n/a n/a n/a NO 04-4741 FTL w r
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refiling Unpaid Balance
of Assessment
(a) b) c) d (e (f
CIVP 06/30/2003 XXX-XX-8376 05/24/2004 06/23/2014 4122.72
CIVP 09/30/2003 XXX-XX-8376 05/24/2004 06/23/2014 3533
76
CIVP 12/31/2003 XXX-XX-8376 05/24/2004 06/23/2014 .
4122.72
******** ********** ************* ********** ************ ***** ***********
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 11779.20
This notice was prepared and signed at DETROIT, MI
the 01st day of April , 2011
Signature
, on this,
Title Director, Campus Compliance
Operations
(MV1t: 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)
Part 1 - RECORDING OFFICE Form 668 (Z) 10-2000)
CAT. NO 600261
1