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1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)( c) Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 -13PZ- }:~
Lien Unit Phone: (BOO) B29-3903 217029605 OS"
As provided by section 6321, 6322, and 6323 of the Internal Revenue <1'14.00 -Pc:{
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made CJEtf-
a demand for payment of this liability, but it remains unpaid. Therefore, /2W
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 /~ I/;/ 9/1a
additional penalties, interest, and costs that may accrue,
Name of Taxpayer WAYNE D LUSH -- ,...,
.
,
Residence ">J
105 RACE ST ,'... .~
BOILING SPRINGS, PA 17007-9794
-,
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, r~""
on the day following such date, operate as a certificate of release as defined ~,)
in IRe 63251a). C)
Tax Period Date of Last D?; for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi 109 of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1987 197-40-7973 10/13/1997 11/12/2007 4826.48
1040 12/31/1996 197-40-7973 05/17/1999 06/16/2009 1182,40
Place of Filing
Prothonotary
Cumberland County Total $ 6008.88
Carlisle, PA 17013
This notice was prepared and signed at
PHILADELPHIA, PA
,on this,
the
04th day of March
2005
Signature
Title
ACS
(800) 829-3903
23-00-0008
for L LEDER
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Ru!. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office
Form 668(Y)(c) IRev. 2-20041
CAT. NO 60025X