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1872
Department of the Treasury - Internal Revenu Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) flt,O~- 3/fi/ F'TI-
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1 - !i. fl'l/ ' /1( fIO
Lien Unit Phone: (800) 829-7650 292937506
As provided by section 6321, 6322, and 6323 of the Internal Revenue :k., ?On
Code, we are ldvIng a notice that taxes (including interest and penalties) e.... /1i7'13
have been assessed against the following-named taxpayer. We have made () ...., 0
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a demand for payment of this liability, but it remains unpaid. Therefore, ""
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there is a Den in favor of the United States on all property and righu to c-- '- :I:.,
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property belonging to this taxpayer for the amount of these taxes, and I. - rnF
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additional penalties, Interest, and cosu that may accrue. I Ul ~~~3 tl
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Name of Taxpayer JAMIE GREENE -0 ;r.; :~J
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Residence -,-, -
PO BOX 315 .~( co --<
BOILING SPRGS, PA 17007-0315
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~1 for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment g of Assessment
Ca) Cb)' (c) (d) Ce) CO
1040 12/31/2001 XXX-XX-8512 02/23/2004 03/25 2014 6175,97
1040 12/31/2003 XXX-XX-8512 08/29/2005 09/28 2015 2392,05
I
Place of Filing
Prothonotary
Cumberland County Total $ 8568,02
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
. on this.
the
23rd day of May
2006
Signature
Title
ACS
(800) 829-765
11-00-0000
for DEBRA K, HURST
(NOTE: Certificate of officer authorized by law totake acknowledgment is not essential to th validity of Notice of Federal Tax lien
Rev, Ru!. 71-466. 1971 - 2 C,8, 4091
Part 1 - Kept By Recordln. OllIe.
Form 668(Y)(e) IRev, 2-2004)
CAT, NO 60025X