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Form 668 (V) 8.36 Doparlmonl ollho Troasury . Inlornol Rsvonue Service
(HI\'. OClob,,' 19931 Notice of Federal Tax Lien
District Serial Number For OpI,ona' Us. by Rocording Ollie.
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As provided by sections 6321, 6322, and 6323 of the 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 lavor 01 the United States on all property and rights to
, property belonging to this taxpayer for the amount 01 these taxel, and
, additional penalties, Interest, and cOlts that may accrue.
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'Name of Taxpayer CM~L E WAllER " ;;
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Residence 16(17 MATTHEW r{D '-..".
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CAMP HILL. PA 1 -(... 11 - 1 I ,.', ,- . :
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, ,. ~: ,., ::x;
unless notice of lien is refiled by the date given In column (e), this notice shall, ...;,.. c.D Cui\ -'Idd'
on the day following such date, operale as a certificate of release as defined "<
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In IRC 632510). ,,-'I n'8l
Tax Period Date 01 Last Day lor Unpaid Balance
Kind of Tax Ended Identifying Number Assessment Rellllng 01 Assessment
(a) (b) (e) (d) (e) (f)
1040 12/:31192 1 ~.~i - 4 .l- .17>-) 1 1.,5/1:2/':-.'3 I}." Ill/f):?: ~')446. 03
,
'Place of Filing
Prl)thl)rll)ta.t'y Total $
Cumber" I and CI)unty 0:"1446..0:3
Ca.-I j s I". PA 17') 1 "
This nolice was prepared and signed al
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the
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Signature
Tille
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IUOTE: Cl'I!;I'C.lln 01 OlllCltr ~Iutholl,,"d b." 1.11'.' 10 l.1~.H ;nlo.r;ll,..l,.dl)r'1l'nl<:. I", P011!!>~ontl.lllo ttlU valldlly 01 Notico of Fodoral Tax lion
fh'", n'll 71 -'fi(l 1911 :! C O. 40~1
Part 1 _ Kept By Rccordlng Office Form 668 (V) (Rov, 10,93)
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Form 668 (Z)
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Doportmont 01 tho Troosury . Intornol Rovonuo Sorvlee
Certificate of Release of Federal Tax Lien
District
Serial Number
For U.. by Recording Ollie.
.u.':;,ccv!
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~ 0\ ~5~';
losl Day lor Unpold Balance
Rellllng 01 Assessment
(e) (t)
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I cenlly thet os to tho lollowlng.nomo toxpoyor, tho roqulromonts 01 seellon 6325 (0)
01 the Internal Revenuo Code hsve boen sallsllod lor the taxes listed below and lor
all stolUlory addlllons. Therelore, tho lion provldod by Codo seellon 6321 lor those
toxos and additions has boen reloased. Tha propor ollleor In Iha olllee where the
notleo 01 Internal rovonuo tnx lion wos 1II0d on ,. " ,:', ,.
19'" . Is In eulhorlzed to nole the books to show tho relooso 01 this lien lor
thoso toxes and additions
Nome 01 Taxpayor I 1-., , "I. f ! "
Rosldenee
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Kind of Tox
(a)
Tax Period
Ended
(b)
Datool
Assessment
(d)
Idenllfylng Number
(c)
Place 01 FIling
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Total
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. on this.
PAnT 1 . nEconOING OFFICE
lNC)lf CI"I,h'.I~t' (I ("kl" ,wlfU'I',.'l"iJ b) '11\ '~I t.11o '-(~. ",1t.~;TIt'''b'~ Nt tS~.f'nf,.I"'" ,hfa Vd1dofy 01 Ct',MCd'e or 1l0lt1ase of FederiJI Ta. ",n Rsv. Rut. 1'-466. '91'.2
elf ,1M)
Form eea (Z) IRev, 5-94)
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