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Department of the Treasury - Internal Revenue Service
Form 668 M(c) Notice of Federal Tax Lien
(Rev. February 2004)
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
860887812
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 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.
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Name of Taxpayer DAVID WILEY pc -
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Residence 109 HIGH MOUNTAIN RD
SHIPPENSBURG, PA 17257-9638
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).
7,
Kind of Tax
(a) Tax Period
Ending
(b)
Identifying Number
(c Date of
Assessment
(d) Last Day for
Refilling
(e) Unpaid Balance
of Assessment
f)
1040 12/31/2003 XXX-XX-2327 02/25/2008 03/27/2018 6830.16
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 6830.16
This notice was prepared and signed at
the
12th day of April
DETROIT, MI
2012
, on this,
Signature -= Title
ACS SBSE 22-00-0001
for P.A. BELTON (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)
Part 1 - Kept By Recording Office CAT. 668(lf (Rev. 2 2004)
CAT. NO 60025X