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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 20041
Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 907815712
As provided by section b321, 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 ilnited States on all property and rights to
property bebnging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer DEBBIE J KOZ
Residence 5241 MEADOWBROOK DR
MECHANICSBURG, PA 17050-6833
For Optional Use by Recording Office
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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, ~ T'
on the day following such date, operate as a certificate of release as defined °~~-S~ ~~ ` L '
in IRC 6325la). ~7~ Ztr `?~~
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiting of Assessment
i.,~ /61 (el [d) (e) (~
CIVP 09/30/2006 XXX-XX-2177 07/25/2011 08/24/2021 359.63
CIVP 03/31/2007 XXX-XX-2177 07/25/2011 08/24/2021 2904.93
CIVP 06/30/2008 XXX-XX-2177 07/25/2011 08/24/2021 7081.43
CIVP 09/30/2008 XXX-XX-2177 07/25/2011 08/24/2021 8961.56
CIVP 12/31/2008 XXX-XX-2177 07/25/2011 08/24/2021 7159.80
CIVP 03/31/2009 XXX-XX-2177 07/25/2011 08/24/2021 6210.37
CIVP 06/30/2009 XXX-XX-2177 07/25/2011 08/24/2021 5681.62
CIVP 09/30/2009 XXX-XX-2177 07/25/2011 08/24/2021 7220.24
CIVP 09/30/2010 XXX-XX-2177 07/25/2011 08/24/2021 5980.57
CIVP 12/31/2010 XXX-XX-2177 0.7/25/2011 08/24/2021 8571.52
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~ $ 6 0131 .6 7
This notice was prepared and signed at DETROIT, MI
the 22nd day of _ November 2012
on this,
Signature /' ;~--~~~~ ACS SBSE 22-00-0001
for P.A. BECTON (-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)(e) (Rev. 2-2004)
Part 1 -Kept By Recording Office CAT. NO 60025X
Form 668 (Z)
(Rev. 10 -2000)
11883 Department of the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
Area:
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 913 -6050
Serial Number
907815712
For Use by Recording Office.
Ltjm: -
la PiailiC0:4;3
MR 15 fai 11: 02
CUMBERLAND
PENNSYLVNSIA
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 December 03
2012
, is authorized to note
the books to show the release of this lien for
these taxes and
additions.
Name of Taxpayer
DEBBIE J KOZLOVAC
Residence 5241 MEADOWBROOK DR
MECHANICSBURG, PA 17050 -6833
COURT RECORDING INFORMATION:
Liber Page UCC No. Serial No.
n/a n/a n/a 12 -7329 FTL
Tax Period
Date of
Last Day for
Unpaid Balance
Kind of Tax
Ending
Identifying Number
Assessment
Refiling
of Assessment
(a)
(b)
(c)
(d)
(e)
(f)
CIVP
09/30/2006
XXX -XX -2177
07/25/2011
08/24/2021
359.63
CIVP
03/31/2007
XXX -XX -2177
07/25/2011
08/24/2021
2904.93
CIVP
06/30/2008
XXX -XX -2177
07/25/2011
08/24/2021
7081.43
CIVP
09/30/2008
XXX -XX -2177
07/25/2011
08/24/2021
8961.56
CIVP
12/31/2008
XXX -XX -2177
07/25/2011
08/24/2021
7159.80
CIVP
03/31/2009
XXX -XX -2177
07/25/2011
08/24/2021
6210.37
CIVP
06/30/2009
XXX -XX -2177
07/25/2011
08/24/2021
5681.62
CIVP
09/30/2009
XXX -XX -2177
07/25/2011
08/24/2021
7220.24
CIVP
09/30/2010
XXX -XX -2177
07/25/2011
08/24/2021
5980.57
CIVP
12/31/2010
XXX -XX -2177
07/25/2011
08/24/2021
8571.52
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Place of Filing
Prothonotary
Cumberland County Total
$
60131.67
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 08th day of April 2014
Signature
Title
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) (Rev. 10 -2000)
Part 1 - RECORDING OFFICE CAT. NO 600261