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499
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. October 20001 720. b.;J. /09.:2- FTt...
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA # 3 f1L. ,. 9.00 P..w
Lien Unit Phone: (BOO) B29-3903 2302B519B
As provided by section 6321, 6322, and 6323 of the Internal Revenue cJ<.-) o~
Code, we are giving a notice that taxes (including Interest and penalties) ~. /::JJ'I~ 2.-
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but It remains unpaid. Therefore,
there 15 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 () 0 ~.
C N ",-"
additional penalties, Interest, and costs that may accrue. -I -~
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Name of Taxpayer KATHIE GRUCZ nln-, ::0 1
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Residence ~c ~. . -'[',
PO BOX 240 )..'":> .-... ~ ':!::l
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CAMP HILL, PA 17001-0240 5>9 0 '-,)
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, (:::l -<
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 Da.r. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref! ng of Assessment
(a) (b\ (c) (d) (e) (f)
1040 12/31/1990 287-56-5274 11/13/2000 12/13/2010 32959.74
1040 12/31/1991 287-56-5274 11/20/2000 12/20/2010 4738.02
1040 12/31/1992 287-56-5274 11/20/2000 12/20/2010 8082.53
1040 12/31/1993 287-56-5274 11/20/2000 12/20/2010 100900.00
1040 12/31/1994 287-56-5274 11/20/2000 12/20/2010 939.93
1040 12/31/1995 287-56-5274 10/09/2000 11/08/2010 8701.94
1040 12/31/1996 287-56-5274 10/09/2000 11/08/2010 10016.37
1040 12/31/1997 287-56-5274 11/27/2000 12/27/2010 838.50
1040 12/31/1998 287-56-5274 09/18/2000 10/18/2010 7162.05
1040 12/31/1999 287-56-5274 09/18/2000 10/18/2010 6792 . 96
Place of Filing
Prothonotary Total $
Cumberland County 181132.04
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
22nd day of February
2002
for L LEDER
Title
ACS
(800) 829-3903
23-00-0008
Signature
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Ru!' 71-466. 1971 ,2 C.B. 409)
Part t . Kept By Recording Office
Form 668(Y)(c) (Rev. 10,00)
CAT. NO 60025X