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1872
Form 668 =r-
~<'.v. February ~)-L._
Are~:
SMl"LL BUSINESS/SELF' EMPj,OYED .z>.REA #3
lien Unit Phone: (8CO) 9l3-6050
Department of "the Treasury - 1nternal Revenue Serv~ce
Notice of Federal Tax Lien
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~2.'-~_~'1:,~!{~'~'-: .~~r~:"!!Y R'~cording Oftl(;~~_____
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As provided by section 6321, 6322, and 6323' of the Il'itf!mal Revenue
Code, we are giving a notice that taxes (induding interest and penalties)
have been assessed against the following-named taxp"yer. We have made
~ demand for payment of this liability, but it remain. unpaid. Therefore,
!here is a lien in favor of ' the United States on all property and rights to
;noperty belonging to this taxpayer for the amount of these taxes, ilnd
additional penalties, interest, and costs that may accrue.
;"3;"e of Taxp-ayer SHARRETTS & BUSH INC a Corparation --
BUSH FOOD SALES INC i
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3107 HF~VARD AVENUE
CAMP HILL, PA 17011-0000
IMPORTANT RElEASE INFORMATION: fryr each assessmeni ',,'ed be/oN,
unless nctice ot tt\t! lien is rAtiled by the date giv&n in col'Jrnn. (e), this notict shnll,
on the day following such date, Dperate as a certificate of relf:ase as defined
ir II~C 6325(al.
. . I Tj!x P~rio~ :. . . I. Date I}f ! !.ast Day for I 1.I"paid gal?;nc..
K:,,~ 'Jf Ta,;; i ' Enc/mg i ;il.mtll'ylnJ!C Number I Assessment I '!lll!fihng : "fAs~">5""..nt
... ..G>L i, (b) 'f'--' (c) --t. (d) __~..- (e) ._.+--~.. (!) ~----_..
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94-1 111:.:~/31,,/2QO.~: S2-(r958G17 11IJ/IO/200SI ".;.:J./~;9/2()-15 ; "\" .")
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941. I 06 -:;O/~~;:I-~~i S::~"-(l958C17 IJ.C/10/:~,~'o:-; 1 :. L/C9/ ;.n~s i ... ~l
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Pr(j!:.'~10r;.otar. y
Cumberldnd~c~nty
Carlisle, 2A 17013
',""h;S-!'lotir:e was nre~'dr8d dl':d s!gned at
PHILADELi"j-J::'A, !"i<
, l/:; ::-,;L~
Ihe__..____o~_nd_ day of
December 2005
Sig"utllre . A~12A/ a f~:-T>~~~tB~U-~ O;",~CE;---'---'-'-~-~-:'r~;~-:~~-';'
fo:r: ,JEFFREY WHITE --1-(717) 221-3490 x13(1)
(NOTE: Certifir;flte of officer authorized by lp.vV to take acknowlerJgmBnt IS not essential to the valirlhy of Notice of ~'ederai,;a:'li;~--~..-
Rev. Rul. 71-466, ~;971 - /. C,B. 409)
Part 1 . Kept By Recording Office
Form 668(Y)(c) IRev, 2,2004;
CAT, NO 60025X