Free Motion to Dismiss - Rule 12(b)(1) - District Court of Federal Claims - federal

..
"

Case 1:06-cv-00228-CFL

Document 11-3

Filed 11/16/2007

Page 1 of 3

United States

of America

Department of the Treasury

Internal Revenue Service
Date: April 4, 2006

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a tre Form 4340, Certificate of Assessments, Payments and Other

Specified Matters for Jerome C. Jewell, SSN: for U.S. Individual Income Tax Return
(Form Hl40), for ta period December 31, 1998, consisting of two pages ~---- _~
~-""

~-

__"c''-

--~-~----~

~"",-,,-'''''~.-.",y

-"~;#"

./
,...-........~"".

..........."....".'''..''.,-

,/ ,~...._""."'....

....- ---"

"...~""..'

i:dê;'the custody of this office.
IN WITNESS WHEREOF, I have hereunto set my hand, and caused the seal of this office to be affixed, on the day and year first above written.
By direction of the Secretary of the Treasury:

Linda L. Drake Supervisor Accounting Technician

r7.~
Form 2866 (Rev, 09-1997)

Ogden W &1 Submission Processing

1
Catalog Number 19002E

SW Delegation Order 198

Exhibit 1, Page 1 of 3

Case 1:06-cv-00228-CFL

Document 11-3

Filed 11/16/2007

Page 2 of 3

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS
JEROME C JEWELL

E IN/SSN:

TYPE OF TAX: U. S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PER IOD: DEC 1998
DATE

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PAYMENT,

ASSESSMENT

DATE (23C, RAC 006 )

ADJUSTED GROSS INCOME

234,002.00 212,208.00

TAXABLE INCOME

04-15-1999 RETURN FILED & TAX ASSESSED

199927

63,109.00
56,186.00 6,923.00
o .00

07-19-1999

04-15-1999 WITHHOLDING & EXCESS FICA
04-19-1999 PAYMENT WITH RETURN 01-30-2004 RECEIVED POA/TIA

ADDITIONAL TAX ASSESSED

20054008
PAGE
1

10-17-2005

FORM 4340 (REV. 01-2002)

Exhibit 1, Page 2 of 3

Case 1:06-cv-00228-CFL

Document 11-3

Filed 11/16/2007

Page 3 of 3

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------JEROME C JEWELL

E IN/SSN:

TYPE OF TAX: U. S. INDIVIDUAL INCOME TAX RETURN

FORM: 1040 TAX PER IOD: DEC 1998
BALANCE

- - -------------- - - - -- - --- - - - - -- - - ----- -- - - - ---- - - -- --- - - -- - - -- - - -- - - - -- -- - - - - ---

0.00 - - --------------- - - - - - ---- - - - - - -- ----- - - - - - - --- - --- - -- - -- ------ - - -- - - - - - - - - - - ---

I CERTIFY THAT THE FOREGOING TRANSCRIPT OF THE TAXPAYER NAMED ABOVE IN RESPECT TO THE TAXES SPECIFIED IS A TRUE AND COMPLETE TRANSCRIPT FOR THE PERIOD STATED, AND ALL ASSESSMENTS, ABATEMENTS, CREDITS, REFUNDS, AND ADVANCE OR UNIDENTIFIED PAYMENTS, AND THE ASSESSED BALANCE RELATING THERETO, AS DISCLOSED BY THE RECORDS OF THIS OFFICE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THEREIN. I

FURTHER CERTIFY THAT THE OTHER SPECIF lED MATTERS SET FORTH IN TH IS TRANSCRIPT
APPEAR IN THE OFFICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

: :::: ~::: -:: - :::~::~::: -::::::~~~ -~~ ~ - - - - - - - - - - - - - - -PRINT NAME:

Linda L. Drake~

TITLE:
DELEGATION ORDER:

Supervisor Accounting Technician, Ogden W&I Submission Processing

SW Delegation Order 198

LOCATION: INTERNAL REVENUE SERVICE
ACCOUNT STATUS DATE 04/04/2006

FORM 4340 (REV. 01-2002)

PAGE

2

Exhibit 1, Page 3 of 3