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Form 668 (Y)(¢)
(Rev. February 2004)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (412) 395-5265 198003504
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 folJowing-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.
Name of Taxpayer BC MCALLISTER PAVING INC , a Corporation
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
)~.OV ' _C'73& F TL-
For Optional Use by Recording Office
Residence
5140 ERBS BRIDGE RD
MECHANICSBURG, PA 17050-2432
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (el, 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 D.a.~ for
Kind of Tax Ending Identifying Number Assessment Refihng
(a) (b) (c) (d) (e)
941 03/31/2004 25-1876578 10/11/2004 11/10/2014
Unpaid Balance
of Assessment
(f)
6457.84
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 6457.84
This notice was prepared and signed at
PHILADELPHIA, PA
· on this,
the 27th dayof October, 2004
Signature ~ Title
REVENUE OFFICER 23-09-1459
for CINDY SIMCOX (717) 221-3490
(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 &68(Y)(¢) (Rev. 2-2004)
Pa~ I - Kept By Recording Office CAT. NO 60025X