HomeMy WebLinkAbout05-6633
1872
Department of the Treasury' Internal Revenue Service
Form 668 (y)(c) Notice of Federal Tax Lien
(Rev. February 2004) ~()S. (, /, 33 r:-'TL
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA # 3 At., P1l./Q,lffi
Lien Unit Phone: (800) 9l3~6050 263329005
As provided by section 6321, 6322, and 6323 of the Internal Revenue tk, / n't
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~./7)l:qo
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 CHARLES R & KAREN S DAVIS (J ",
c: ''''' 0
=
:c- c..n .,
""D i~r <::> ......
mf;- fT1 :::C:n
z-,.
Residence 19 TUSCANY CT :Z:" . ("") nlp-.;;..
CJ? c'> - '"Om
CAMP HILL, PA 17011-1029 ~.;: '-0 ;!<O
.':':::!(:l
-0 -.- "'~',
IMPORTANT RELEASE INFORMATION: For each assessment listed below, ~~i'''' ::1:1: <~ if~
5> '. r:Sntt
unless notice of the lien is refiled by the date given in column (e), this notice shall, C ~
-.;;.~ ~
on the day following such date, operate as a certificate of release as defined '::'1 en
in IRC 6325(a), -< :n
U1 -<
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refihng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2002 172-36-1023 06/21/2004 07/21/2014 40478.98
1040 12/31/2003 172-36-1023 06/28/2004 07/28/2014 2012.63
Place of Filing
Prothonotary
Cumberland County Total $ 42491. 61
Carlisle, PA 17013
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the
09th day of December
2005
Signature /f / ./
'A4tZA./ u- 17~
for DAVID M. SHROYER
Title
REVENUE OFFICER
(717) 221-3490 x1320
23-06-1442
(NOTE: Certificate of officer authorized bV law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev, Ru!. 71'466.1971,2 C,B. 4091
Part t .. Kept By Recording Office
Form 668(Y)(c) (Rev, 2,20041
CAT. NO 60025X