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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(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 114278614 1�
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 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 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. .70
Name of Taxpayer LEROY E SR & JAYNE C FREY
C� Sa► p—r•.
T>C-)
Residence 2 514 ROLO CT 00
MECHANICSBURG, PA 17055-5898 :t-•
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,
on the day following such date, operate as a certificate of release as defined 4;R • m
in IRC 6325(a). 7t 3Q�99/
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)
1040 12/31/2002 XXX-XX-0480 09/05/2005 10/05/2015 12664 . 78
1040 12/31/2004 XXX-XX-0480 04/30/2007 05/30/2017 4464 . 57
1040 12/31/2005 XXX-XX-0480 01/11/2010 02/10/2020 1130 .34
1040 12/31/2006 XXX-XX-0480 01/11/2010 02/10/2020 25434 .69
1040 12/31/2007 XXX-XX-0480 09/09/2011 10/09/2021 2113 . 88
1040 12/31/2008 XXX-XX-0480 09/09/2011 10/09/2021 4614 . 55
Place of Filing
Prothonotary
Cumberland County Total $ 50422 . 81
Carlisle, PA 17013 .
This notice was prepared and signed at DETROIT, MI , on this,
the lith day of August 2014
Signature Title
�-� ACS W&I 11-00-0000
for DEANN BENDER (800) 829-7650
(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(Y)(c) (Rev. 2-2004)
CAT. NO 60025X