HomeMy WebLinkAbout06-3190
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4719
Form 668 (Y)(C)
(Rev. February 2004)
Department of the Treasury - Internal Reven e Service
Notice of Federal Tax Liel1 /11> ()(,_ ..)J'}o F rL
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #5
Lien Unit Phone: (800) 913-6050 293318606
As provided by section 6321, 6322, and 6323 ofthe Internal Revenue
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,
there Is a lien In favor of the United Scates on all property and rlpts Co
property belonging Co this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer JEFFREY S MILLER
For Optional Use by Recording Office
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Residence
102 LIMESTONE DR
CAMP HILL, PA 17011
IMPORTANT RELEASE INFORMATION: For each assessment listed below.
unless notice of the lien is refiled by the date given in column (a), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRe 6325(a),
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Tax Period Date of Lase D~ for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment RefI ng of Assessment
(a) (b) (c) (d) (e CO
1040 12/31/1997 XXX-XX-2628 05/04/1998 06/03 2008 784,00
1040 12/31/1999 XXX-XX-2628 03/20/2006 04/19 2016 2156,00
1040 12/31/2000 XXX-XX-2628 OS/28/2001 06/27 2011 2224,00
1040 12/31/2003 XXX-XX-2628 02/20/2006 03/21 2016 2747,00
1040 12/31/2004 XXX-XX-2628 02/20/2006 03/21 2016 5982,00
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
13893,00
This notice was prepared and signed at
DETROIT, MI
23rd day of May
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Signature _ ':( 4. 'r1i 1/;'f, 1/1
for THERESA HARLEY
the
2006
Title
ACS
(800) 829-390
25-00-0008
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to th validity of Notice of Federal Tax lien
Rev, Ru!. 71-466,1971 - 2 C,8, 409)
, on this,
Part 1 . Kept By Recordlna Office
Form 668(Y)(c) IRev, 2-2004)
CAT, NO 60025X