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1872 Department of the Treasury - Internal Reven~e Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) "llAOl.-.3O% (:,TL-
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 P1i ./'1.00
Lien Unit Phone: (800) 829-3903 292113606 t..
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As provided by section 6321, 6322, and 6323 of the Internal Revenue CJt.. V 'i' (.{,
Code, we are giving a notice that taxes (Including Interest and penalties) R.....-. 11f(J<P!
have been assessed against the following-named taxpayer. We have made
a demand for payment of this IlabUIty, but It remains unpaid. Therefore, I
there Is a lien In favor of the United States on aU propeny and rights to I () .....,
propeny belonging to this taxpayer for the amount of these taxes, and I = 0
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additional penalties, Interest, and costs that may accrue. I ~..,.. 0"'
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Name of Taxpayer WALTER H HUMPHREY JR -: ,.
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Residence - -0 ,',,')-Tl
39 MALLARD CT "" :a: "7(')
MECHANICSBURG, PA 17055-4334 N 25rn
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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 IRC 6325(a).
Tax Period Date of Last':.aa for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref! g of Assessment
Ca) Cb) (c) Cd) (e) en
1040 12/31/1998 XXX-XX-3687 07/25/2005 08/24 2015 360.10
1040 12/31/2003 XXX-XX-3687 05/30/2005 06/29 2015 13000.29
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Place of Filing
Prothonotary
Cumberland County Total $ 13360.39
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 18th day of May 2006
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Signature . ff. Il Yn till111 Title
ACS 22-00-0008
for REGINA OWENS (800) 829-3903
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to th validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev. 2-20041
Part 1 - Kept By Recording Office
CAT. NO 60025X