HomeMy WebLinkAbout12-5211Form 668 (Y)(c)
(Rev. February 2004)
11883
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 887787712
As provided by section 6321, 6322, and 6323 of the Internal Revenue ?72-
Code, we are &Ing 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 irk 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. 3t2• _
.°
Name of Taxpayer JAMES I MCMILLEN MD F A C R ?
r
Residence 1001 S MARKET ST STE D '7
C7
4
MECHANICSBURG, PA 17055-4748 ".
IMPORTANT RELEASE INFORMATION: For each assessment listed below, C"
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 Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
941 03/31/2011 30-0026368 07/11/2011 08/10/2021 4772.34
941 06/30/2011 30-0026368 09/26/2011 10/26/2021 8154.86
941 09/30/2011 30-0026368 01/09/2012 02/08/2022 6783.93
941 12/31/2011 30-0026368 04/16/2012 05/16/2022 13185.39
941 03/31/2012 30-0026368 07/02/2012 08/01/2022 9867.35
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 42763.87
This notice was prepared and signed at
the 14th day of August
DETROIT, MI
2012
, on this,
Signature ?? Title
\C--CS4'- REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(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 1 - Kept By Recording Office CAT. NO 60025X
11883 Department of the Treasury -Internal Revenue Service
Form 668 (Z)
iRev. 70-2000) 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 887787712
I certify that the following-named taxpayer, under the requirements of section 6325 (a)
of the Interns! 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 21 ~ ,`.,~
r..o
2 012 is authorized to note the books to show the release of this lien for ~pq p ~ ~~
these taxes and additions. ~~
~~ ~ ~
e-~ ~~,
Name of Taxpayer U's~,,.
~ ~ ~~`
~
JAMES I MCMILLEN MD F A C R r
--~ -~
~•~
;
~ ~c~:
p'
Residence 1001 S MARKET ST STE D ~ ~--,
MECHANICSBURG, PA 17055-4748 '~' ~~- -~"
COURT RECORDING INFORMATION : 9. S~ P~~ ~-;
Liber Page UCC No. Serial No.
n/a n/a n/a 12-5211 FTL ~ ~ ~3 ~7
Tax Period Date of Last Dayy for unpaid Balance
Kind of Tax Ending Identifying Number Assessment Reflling of Assessment
a b) c d (e (f
941 03/31/2011 30-0026368 07/11/2011 08/10,/2021 4772.34
941 06/30/2011 30-0026368 09/26/2011 10/26/2021 8154.86
941 09/30/2011 30-0026368 01/09/2012 02/08/2022 6783.93
941 12/31/2011 30-0026368 04/16/2012 05/16/2022 13185.39
941 03/31/2012 30-0026368 07/02/2012 08/01/2022 9867.35
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 42763.87
This notice was prepared and signed at
the 21st day of November
DETROIT, MI
2012,
on this,
Signature ~~~ Operations Manager,
Centralized Case Processing-Lien Unit
(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 668 {Z) IRev. 10-2000)
Pan 1 -RECORDING OFFICE CAT. NO 600261