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, Dopartmenl oflho Traosury . Intornal Rovonuo Sorvlco
'Form 668 (Y)
, Notice of Federal Tax Lien
,(AIV, Oelob., 100J)
District Sorial Number For Optlontl' Uso by Recording Ollies
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A, provided by sections 6321, 6322, ond 6323 01 tho Internal Revenue .) -
Code, we ara giving a notice thet to xes (Including Interost ond penollles)
hive been assessed agolnst the followlng'nemed taxpayer. We have made I=IL
I demand for payment 01 this lIablllly, but It remolns unpold. Therefore, ",
there la a lien In favor of the Unlled Ststes on ell proporty end rights to ,
property belonglnA to this taxpayer for tha omount 01 these toxes, and ,
, Iddlllonal penalties, Interest, and costs thet moy eccrue.
,Name 01 Toxpayer ....
ROfJE:IH C<. SANDRA COr~NMAN 0.'
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Residence -'"
RENO 8T -
416 U)
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! NEW CUMBERLAND. F'A t7070
IMPORTANT RELEASE INFORMATION: For each assessmenllisled beloW. 11</.(10,) pd
unless nollce 01 lien Is rellled by the dale given in column (e), Ihls notice shall, u\!\ '3ul55
on the day lollowlng such date, operate as a certificate 01 reloase as dellned
i In IRe 632 . - R.~I :NPI~'
Tax Period Date 01 Last Day for Unpaid Balance
Kind of Tax Ended Identifying Number Assessment Reflllng of Aaaeaament
i (a) (b) (c) (d) (e) (f)
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t040 t2l3t/8E 172:-<)i:..-ZO;":il tH:~/ 16/:39 06/14/'.~9 9902:.2.:3
,Place of Filing Pt'l) thuD') t at")'
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Cumberla.nd C..unl., Total $ 9')O.::~. ~:8
, Cat. I is I". F'A 170 1 ~:
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This notice was prepared and signed at
, on this,
PII i I 'j, J., I ""1., .a I p~
the t c, H, day 01
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tNOTE: C.,'lihcaltl ot tJIlII:llr .IUP'Ofllf',l by u.... t,; t.\~" ,I' ~r'r),\I",hl"~t"~!'." 1',)Il";'.'~lll,,1i I;] 11111 "i1!lllilV 01 nutlell uf Fuclulal T.u lion
nov nul 71,41iG. 1'3,'1 ~ C B 4(1'l1
ParI 1 . Kept Dy Recording Office
Fo,m 668 (Y) (Rov, 10.931
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