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1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax: Lien
(Rev. February 2004) )~ ()~J. Y&O'l F7 L-
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 -?a. fJ'7f "/'/. UV
Lien Unit Phone: (800) 913-6050 244546405
As provided by section 6321, 6322, and 6323 of the Internal Revenue cA. {, t 75'
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made tfL /031Y
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 DONALD A BLOSSER & BREDENA E MCNAIR n '"
c:;.) C)
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(0"') :;:l
Residence 403 5TH ST BOX 95 )i'j
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SUMMERDALE, PA 17093-0095 1 --,-1
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, -_.~ ,f:
_.. ,
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 (,,,J
in IRC 6325(al. en
1'0
Tax Period Date of Last Da.r. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi Ing of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1986 193-38-2035 12/22/1997 01/21/2008 6988.95
Place of Filing
Prothonotary
Cumberland County Total $ 6988.95
Carlisle, PA 17013
This nolice was prepared and signed at
PHILADELPHIA, PA
, on this,
23rd day of August
2005
the
for GEORGE
al/~
Title
TXPYR RES REP
(717) 221-3490
23-50-1073
Signature
(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. 4091
Part 1 - Kept By Recording Office
Form 668(Y)(c) IRev. 2-20041
CAT. NO 60025X