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Department of the Treasury - Internal Revenue Service
Form 668 ( 2004)
(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) 913 -6050 936373613
As provided by section 6321, 6322, and 6323 of the Internal Revenue / 3 d VS % G-
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, C:: C=
there is a lien in favor of the United States on all property and rights to rrim w.-n
property belonging to this taxpayer for the amount of these taxes, and X rn :bW Fri_
additional penalties, interest, and costs that may accrue. tnr rn
Name of Taxpayer GRIFFS FLOORING, a Partnership
CLIFTON GRIFFITHS PTR & SEAN GRIFFTHS PTR A >�
23 sac:
Residence 119 N SPORTING HILL RD V -
MECHANICSBURG, PA 00017 -0050
IMPOR NT RELEASE INFORMATION: For each assessment listed below,
unless ne of the lien is refiled by the date given in column (e ), this notice shall,
on the following such date, operate as a certificate of release as defined
in IRC 5(a). �G�oZ
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) I (d) (e) (f)
941 09/30/2004 20- 0867689 03/06/2006 04/05/2016 8212.07
941 03/31/2006 20- 0867689 06/26/2006 07/26/2016 7099.25
Place of Filing
Prothonotary
Cumberland County Total $ 15311.32
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 26th day of April 2013
Signature Title
REVENUE OFFICER 22 -06 -1413
for LINDSEY O BOWLIN (717) 777 -9623
(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 Form 668( CAT (Rev. 025X )
CAT. NO 60025X