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1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(C)
(Rev. February 2004)
Notice of Federal Tax Lien
/1" 11":- lJ 7 71( F-r"-
For Optional Use by Recording Office
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 913-6050 246564205
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.
Name of Taxpayer SHARRETTS & BUSH INC , a Corporation
BUSH FOOD SALES INC
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Residence
3107 HARVARD AVENUE
CAMP HILL, PA 17011
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 IRe 6325(a).
Tax Period Date of Last Da;y for
Kind of Tax Ending Identifying Number Assessment Refihng
(a) (b) (c) (d) (e)
940 12/31/2003 52-0958017 08/08/2005 09/07/2015
941 03/31/2003 52-0958017 07/11/2005 08/10/2015
941 06/30/2003 52-0958017 07/11/2005 08/10/2015
941 09/30/2003 52-0958017 07/11/2005 08/10/2015
941 12/31/2003 52-0958017 07/11/2005 08/10/2015
941 03/31/2004 52-0958017 10/11/2004 11/10/2014
941 06/30/2004 52-0958017 08/01/2005 08/31/2015
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
This notice was prepared and signed at
PHILADELPHIA, PA
the 02nd day of September, 2005
Signature
Title
REVENUE OFFICER
(717) 221-3490
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for JEFFREY
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Unpaid Balance
of Assessment
(f)
214.07
5657.46
8039.40
6857.94
11083.93
7980.56
9390.66
49224.02
, on this,
23-09-1450
Part t - Kept By Recording Office
(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)
CAT, NO 60025X