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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording !Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 878676612
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, r.,
there is a lien in favor of the United States on all property and rights to rnm c
property belonging to this taxpayer for the amount of these taxes, and :Z;o r-" -3r
additional penalties, interest, and costs that may accrue.
1
Name of Taxpayer DAVID G CONNOR z„ -
CA
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Residence 3408 HAWTHORNE DR
CAMP HILL, PA 17011-2718
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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unless notice of the lien is refiled by the date given in column (e), this notice shall, c
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). 07 ???/s
Tax Period Date of Last Day for Unpaid Bah nce
Kind of Tax Ending Identifying Number Assessment Reflng of Assessm nt
(a) (b) (c) (d) (e) (f)
1040 12/31/2004 XXX-XX-5938 10/10/2005 11/09/2015
1040 12,/31/2004 XXX-XX-5938 03/19/2007 04/18/2017 973.03
1040 12,/31/2006 XXX-XX-5938 04/11/2011 05/11/2021 614 4.88
1040 12,/31/2007 XXX-XX-5938 04/11/2011 05/11/2021 2828.59
1040 12/31/2008 XXX-XX-5938 04/11/2011 05/11/2021 9831.63
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Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 7517$.13
This notice was prepared and signed at
the 29th day of June
DETROIT, MI
2012
, on this,
Signature Title
for
\ ACS SBSE 22-00-0001
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,li
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part I - Kept By Recording Office CAT. 668( (Rev. 41
CAT. NO 6000025 25X