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Department of the Treasury" Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
IRev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 829-3903 240984005 O.J- 411.,." "fit..
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, jcl Pft --R 1'1- ./
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. <: 0'7 A ->-
Name of Taxpayer ARCHIE W STAKE a Iro7.5(<I-
Residence 9494 NEWBURG RD
NEWBURG, PA 17240-9623
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
in IRC 6325(a).
Tax Period Date of Last Dal. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi ng of Assessment
(a) (b) (c) (d) (e) (f)
l040 12/31/1995 196-40-3406 OS/20/1996 06/19/2006 169.99
1040 12/31/2000 196-40-3406 09/01/2003 lO/01/2013 24480.9l
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Place of Filing
Prothonotary
Cumberland County Total $ 24650.90
Carlisle, PA 17013
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This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
02nd day of August
2005
the
Signature
Title
ACS
(800) 829-3903
23-00-0008
(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.8. 409)
Part 1 . Kept By Recording OfIke
Form 668(Y)(c) IRev. 2-20041
CAT. NO 60025X