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Department of the Treasury - Internal Revenue Service
Form 668 MW
(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) 829-3903 133239614
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
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additional penalties, interest, and costs that may accrue. =:�� C") -V
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Name of Taxpayer MIKE S GOODHART �>
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Residence 184 TEXACO RD 5:
MECHANICSBURG, PA 17050-2624
IMPORTANT
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,
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:dt y following such date, operate as a certificate of release as defined
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Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) W (d) (e) M
1040 12/31/1996 XXX-XX-8279 05/23/2005 06/22/2015
1040 12/31/1997 XXX-XX-8279 05/30/2005 .06/29/2015 3122 .81
1040 12/31/1998 XXX-XX-8279 05/16/2005 06/15/2015 11348. 04
1040 12/31/1999 XXX-XX-8279 05/16/2005 06/15/2015 20879 . 83
1040 12/31/2000 XXX-XX-8279 05/16/2005 06/15/2015 12943 .84
1040 12/31/2001 XXX-XX-8279 09/19/2005 10/19/2015 3810 . 08
CIVP 12/31/2007 XXX-XX-8279 06/28/2010 07/28/2020 18164 .50
CIVP 12/31/2008 XXX-XX-8279 06/28/2010 07/28/2020 3457. 39
Place of Filing
Prothonotary
Cumberland County Total 73726 .49
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 04th day of December 2014.
SignatureTitle
ak�� ACS SESE 22-00-0001
for P.A. BELTON 1L./ (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)(c) (Rev. 2-2004)
Part 1 -Kept By Recording Office rAT hirl Ann)RV