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1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) 11>> O(y 1\7~ r=-n
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 -n f:cIJ/ . n. ,~)
Lien Unit Phone: (800) 829-3903 280134606
As provided by section 632 t, 6322, and 6323 of the Internal Revenue 0.....- J5X-
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, .t:::_v. 1'1".110
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 JAY M WAY & MARY I WHITEHEAD-WAY () ,....,
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Residence r-;-j:T:
1453 COCKLEYS MEADOW DR ,-
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BOILING SPRGS, PA 17007-9687 ,," ~~j:
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IMPORTANT RELEASE INFORMATION: For each assessment listed below. _m~ ,
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unless notice of the lien is refiled by the date given in column (e), this notice shall, C) ,,)
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on the day following such date, operate as a certificate of release as defined i'.! :.
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in ]Re 6325(a). ...-.: -'<:
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 12/31/2000 XXX-XX-4835 09/30/2002 10/30/2012 474.57
1040 12/31/2001 XXX-XX-4835 01/06/2003 02/05/2013 33150.31
Place of Filing
Prothonotary
Cumberland County Total $ 33624.88
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
, on this,
the
21st day of March
2006
Signature
Title
ACS
(800) 829-3903
22-00-0008
for REGINA OWENS
(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. 4091
Part 1 - Kept By Recording Office
Form 668(Y)(c) IRev. 2-20041
CAT. NO 60025X