Free Joint Preliminary Status Report - District Court of Federal Claims - federal

Case 1:05-cv-00773-EJD
.._~ )

Document 13-13

Filed 01/26/2006

Page 1 of 25

United States

of America

Department of the Treasury

Internal Revenue Service

Date: October 21,2005

CERTIFICATE OF OFFICIAL RECORD

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

Specified Matters for Kelly T. Hickel, SSN: 1999, consisting of two page

for Civil Penalty, for tax period June 30,

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:

..

.. EXHIBIT .;

~~ CX- l)hhc
Linda L. Drake Supervisor Accounting Technician
SW Delegation Order 198
Ogden W &1 Submission Processing
Form 2866 (Rev. 09-1997)

l / i
Catalog Number 19002E

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 2 of 25

-- -- -- - --- - --- - --- - --- - --- -- ----- ---- - -- ---- - ---- - ---- -- -- - - - -- ------- - - ---- ---KELLY T HICKEL

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

EIN/SSN:

FORM: CVPN TAX PER IOD: JUNE 1999
DATE

TYPE OF TAX: CIVIL PENAL TY

EXPLANATION OF TRANSACTION

-- - -- --- -- - - ----- ----------- - -- --- -- - -- --- ------ ----- -- -- --- ---- ------- ---- - - --PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENALTY

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PA YMENT ,

DATE (23C, RAC 006 )

ASSESSMENT

3.94

11-14-2003

29251- 318-1450 3- 3
o .00

PROMPT ASSESSMENT

29251- 318-1450 3- 3

11-14-2003 12-22-2003

200350

INTEREST ASSESSED

0.02
3.96 100.00

12-22-2003 UNDERPAYMENT CLEARED
01-13- 20 04 SUBSEQUENT PAYMENT

MISCELLANEOUS PAYMENT

01-05-2004 RECEIVED POA/TIA 01-13-2004 OVERPAYMENT CREDIT
TRANSFERRED

ClOO.OO)

1040 200212

01-13-2004 XREF 100% PENALTY

84-1458582

941 199906

01-13-2004 XREF 100% PENALTY

99906
PAGE
1

11-14-2003 Statutory Notice of Balance Due

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 3 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------KELLY T HICKEL

EIN/SSN:

FORM: CVPN TAX PER IOD: JUNE 1999
BALANCE

TYPE OF TAX: CIVIL PENALTY

--------------------------------------------------------------------------------------------------------------------------------------------------------------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 SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

: :::: :::: -~: - ::::::~::: - ::: :::~~;; ~~ -: -~ ~ )G~~Æ~ - - - - - - - - - - - - - - - -PR INT NAME: Linda L. Drake
TITLE:
DELEGATION ORDER:
Supervisor AccountinQ Technician, OQden W&I Submission Processing

SW DeleQation Order 198

LOCATION: INTERNAL REVENUE SERVICE
ACCOUNT STATUS DATE 10/21/2005

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 4 of 25

United States

of America

Department of the Treasury

Internal Revenue Service
Date: October 2l, 2005

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a tre Form 4340 C

Specified Matters for Kelly T. Hickel, SSN:
September 30, 1999, consisting of

, ,

Assessments Payments and Other

, for Civil Penalty, for tax period

four page

~
der the custody of this offce.
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:

-

.. EXHIBIT .;

of ;L
B

I

Linda L. Drake Supervisor Accounting Technician

(ß~ rfVISML
Form 2866 (Rev. 09-1997)

Ogden W &1 Submission Processing

SW Delegation Order 198
Catalog Number 19002E

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 5 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -KELLY T HICKEL

EIN/SSN:

FORM: CVPN TAX PER IOD: SEPT 1999
DATE

TYPE OF TAX: CIVIL PENALTY

-------------------------------------------------------------------------------PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENALTY 29251- 318-14504- 3

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DEB ITS

(REVERSAL)

CREDIT (REVERSAL)

PA YMENT ,

ASSESSMENT

DATE (23C, RAC 006 )

13,401.75
0.00

11-14-2003

PROMPT ASSESSMENT
29251- 318-14504- 3

11-14-2003
12-22-2003
100.00

200350

INTEREST ASSESSED

55.92

01-13-2004 SUBSEQUENT PAYMENT MISCELLANEOUS PAYMENT
02-09-2004 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM

01-05-2004 RECEIVED POA/TIA 01-13-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

100.00-

RECOVERY PENALTY /RELA TED PERSONAL CREDIT

IRC 6672 TRUST FUND

83254-441- 53063-4
ADJUSTMENT

01-13-2004 MISCELLANEOUS PENALTY
RECOVERY PENALTY /RELA TED PERSONAL CREDIT

100.00-

IRC 6672 TRUST FUND

83254-441- 53064-4

FORM 4340 (REV. 01-2002)

PAGE

1

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 6 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------KELLY T HICKEL

EIN/SSN:

FORM: CVPN TAX PER IOD: SEPT 1999
DATE

TYPE OF TAX: CIVIL PENALTY

EXPLANATION OF TRANSACTION

-------------------------------------------------------------------------------01-13-2004 XREF 100% PENALTY

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PA YMENT ,

ASSESSMENT

DATE (23C, RAC 006 )

99909

01-13-2004 XREF 100% PENALTY

941 199909
84-1458582

06-28-2004 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM
07- 0 5-20 04 MODULE IN FEDERAL PAYMENT LEVY PROGRAM

07-19-2004 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM

06-14-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

13,101.75-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

83254-615-53052-4

06-14-2004 MISCELLANEOUS PENALTY
ADJUSTMENT
RECOVERY PENALTY /RELA TED PERSONAL CREDIT

53.95-

IRC 6672 TRUST FUND

83254-615- 53054-4

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 7 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------KELLY T HICKEL

EIN/SSN:

TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PERIOD: SEPT 1999
DATE

EXPLANATION OF TRANSACTION

-------------------------------------------------------------------------------06-14-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PAYMENT,

ASSESSMENT

DATE (23C, RAC 006 )

1.97-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT
83254-615- 530 55-4

08-27-2004 fEDERAL TAX LIEN

08-16-2005 LEGAL SUIT PENDING
11-14-2003 Statutory Notice of Balance Due

FORM 4340 (REV. 01-2002)

PAGE

3

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 8 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -KELLY T HICKEL

EIN/SSN:

FORM: CVPN TAX PER IOD: SEPT 1999
BALANCE

TYPE OF TAX: CIVIL PENALTY

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

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 SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

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

0.00

: ::::NT NAME: Linda L. Drake:::: ZA~ ll - Z1).lJii - - - - - - - - - - - - - - -:::: -:: - ::::::~::: - ::: PR I
TITLE:
DELEGATION ORDER:
Supervisor Accountina Technician. Oaden W&i Submission Processing

SW Delegation Order 198

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 10/21/2005

FORM 4340 (REV. 01-2002)

PAGE

4

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 9 of 25

United States

of America

Department of the Treasury

Internal Revenue Service
Date: October 21, 2005

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a tre Form 4340, Certificate of Assessments, Payments and Other Specified Matters for Kelly T. Hickel, SSN: , for Civil Penalty, for tax period
December 31, 1999, consisting of four pages

--..-

/,...."'...-_....

~',.~'

,.-

"..' ~...---

~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:

....-~_...
,.....~"

uñdêr the custody of this offce.

~ EXHIBIT c
i

(~..-i~ d; . ÁkJIL
Li:;a L~trake
Supervisor Accounting Technician
Ogden W &1 Submission Processing

l '-~ i

SW Delegation Order 198
Catalog Number 19002E
Form 2866 (Rev. 09-1997)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 10 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

KELLY T HICKEL EIN/SSN:
TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PER IOD: DEC 1999
DATE

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PA YMENT,

ASSESSMENT

DATE (23C, RAC 006 )

PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENALTY 29251-318-14505- 3

155,616.32
0.00
649.36
100.00

11-14-2003

PROMPT ASSESSMENT

29251-318-14505-3
200350

11-14-2003 12-22-2003

INTEREST ASSESSED

01-13-2004 SUBSEQUENT PAYMENT MISCELLANEOUS PAYMENT
02-09-2004 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM

01-05-2004 RECEIVED POA/TIA

01-13-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

100.00-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

83254-441- 53065-4

12-22-2003 XREF 100% PENALTY

99912
PAGE
1

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 11 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, -------------------------------------------

AND OTHER SPECIFIED MATTERS

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

KELLY T HICKEL EIN/SSN:
FORM: CVPN TAX PER IOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

ASSESSMENT PA YMENT , ASSESSMENT, DATE (23C, CREDIT OTHER DEBITS RAC 006 ) (REVERSAL) (REVERSAL) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - --

EXPLANATION OF TRANSACTION

12-22-2003 XREF 100% PENALTY

84-1458582

941 199912

06-28-2004 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM

06-21-2004 SUBSEQUENT PAYMENT MISCELLANEOUS PAYMENT 07-05-2004 MODULE IN FEDERAL PAYMENT LEVY PROGRAM
04-15-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

1,500.00

o .24-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

83254- 584- 53069-4
ADJUSTMENT

04-15-2004 MISCELLANEOUS PENALTY
IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

16,530.94-

83254-584- 530 70 - 4

07-19-2004 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM

08-27-2004 FEDERAL TAX LIEN

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 12 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, -------------------------------------------

AND OTHER SPECIFIED MATTERS

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

KELLY T HICKEL EIN/SSN:
FORM: CVPN TAX PER IOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

EXPLANATION OF TRANSACTION

OTHER DEB I TS

ASSESSMENT,

- - -- - - - - - - - -- - - ---- - - - - - - --- - - --- - - --- - - -- --- - -- -- -- - - - - - - --- -- - - - -- - - - - - -- - - --08-16-2005 LEGAL SUIT PENDING
11-14-2003 Statutory Notice of Balance Due

(REVERSAL)

CREDIT (REVERSAL)

PA YMENT ,

ASSESSMENT

DATE (23C, RAC 006 )

FORM 4340 (REV. 01-2002)

PAGE

3

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 13 of 25

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

CERTIF ICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIF lED MATTERS

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

KELLY T HICKEL EIN/SSN:
FORM: CVPN TAX PER IOD: DEC 1999
BALANCE

TYPE OF TAX: CIVIL PENALTY

--------------------------------------------------------------------------------------------------------------------------------------------------------------138,034.50

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 SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

: :::: :::: -~: - :::: ::~ ::: - ~:: :::~~;~l~ - ~~ -, -fJl/J - - - - - - - - - - - - - - -PRINT NAME: Linda L. Drake
TITLE:
DELEGATION ORDER:
Supervisor Accountinçi Technician, Dçiden W&I Submission Processing

SW Deleçiation Order 198

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 10/21/2005

FORM 4340 (REV. 01-2002)

PAGE

4

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 14 of 25

United States

of America

Department of the Treasury

Internal Revenue Service
Date: October 21, 2005

CERTIFICATE OF

AL RECORD

I certify that the annexed: is a tre Form 43 Specified Matters for David Sunshine, SSN:

1999, consisti

of Assessments Payments and Other for Civil Penalty, for tax period June 30,

, pages ,. two

./ .-.~.. ~ the custody of this offce.
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:

..~

-

l Xii !
i

.. EXHIBIT .;

~-lk ~.IJ~
Linda L. Drake Supervisor Accounting Technician
Ogden W &1 Submission Processing

SW Delegation Order 198
Form 2866 (Rev. 09-1997)

Catalog Number 19002E

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 15 of 25

CERTIF ICATE OF ASSESSMENTS, PAYMENTS. AND OTHER SPECIF lED MATTERS --------------------------------------------------------------------------------

DAVID SUNSHINE

E IN/SSN:

TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PER IOD: JUNE 1999
DATE

EXPLANATION OF TRANSACTION

-------------------------------------------------------------------------------PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENALTY

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PAYMENT,

ASSESSMENT

DATE (23C, RAC 006 )

3.94

11-14-2003

29251- 318-1450 0 - 3
PROMPT ASSESSMENT

29251-318-14500-3
200350

0.00

11-14-2003 12-22-2003

INTEREST ASSESSED

0.02
3.96 100.00

12-22-2003 UNDERPAYMENT CLEARED

01-13-2004 SUBSEQUENT PAYMENT MISCELLANEOUS PAYMENT

01-05-2004 RECEIVED POA/TIA
01-13-2004 OVERPAYMENT CREDIT

(100.00)

01-13-2004

CVPN 199909 XREF 100% PENALTY 941 199906 84-1458582
99906
PAGE
1

TRANSFERRED

01-13-2004 XREF 100% PENALTY

11-14-2003 Statutory Not ice of Ba lance Due

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 16 of 25

- - - - - - - - - - - - - - - - - - - - - - - - - - -- - -- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -DAVID SUNSH INE

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS

E IN/SSN:

TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PER IOD: JUNE 1999
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 SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFFICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

: :::: ~::: -:: - :::~ ::~ ::: -Drake CZ-;; -l~- -, -1~~-,-1J -w - - - - - - - - - - - - - - -:::: ::: PRINT NAME: Linda L.
TITLE:
DELEGATION ORDER:
Supervisor Accountinq Technician, Oqden W&I Submission Processing

SW Delegation Order 198

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 10/21/2005

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 17 of 25

United States

of America

Department of the Treasury

Internal Revenue Service
Date: October 21, 2005

CERTIFICATE OF OFFICIAL RECORD

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

Specified Matters for David Sunshine, SSN:
September 30, 1999, consisting of

2, for Civil Penalty, for tax period

three pages

u~e custody of this offce.
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:

-

.. EXHIBIT

.; L j ~
~

Linda L. Drake Supervisor Accounting Technician
SW Delegation Order 198

~CX,l&&k
Form 2866 (Rev. 09-1997)

ï

Ogden W &1 Submission Processing

Catalog Number 19002E

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 18 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -DAVID SUNSHINE

EIN/SSN:

FORM: CVPN TAX PERIOD: SEPT 1999
DATE

TYPE OF TAX: CIVIL PENALTY

ASSESSMENT PAYMENT, ASSESSMENT, DATE (23C, CREDIT OTHER DEBITS RAC 006 ) (REVERSAL) (REVERSAL) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - -- - - - - - - - - --

EXPLANATION OF TRANSACTION

PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENALTY

13,401.75
0.00

11-14-2003

29251- 318-1450 1- 3
PROMPT ASSESSMENT

29251-318-14501-3
200350

11-14-2003

INTEREST ASSESSED

55.92
100.00

12-22-2003

01-13- 20 04 SUBSEQUENT PAYMENT

MISCELLANEOUS PAYMENT

02-09-2004 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM 01-05-2004 RECEIVED POA/TIA

01-13-2004 OVERPAID CREDIT APPLIED

CVPN 199906
ADJUSTMENT

100.00

01-13-2004 MISCELLANEOUS PENALTY
RECOVERY PENALTY /RELA TED PERSONAL CREDIT

100.00-

IRC 6672 TRUST FUND

83254-440 - 530 71- 4

01-13-2004 XREF 100% PENALTY

99909
PAGE
1

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 19 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -DAVID SUNSHINE

EIN/SSN:

TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PERIOD: SEPT 1999
DATE

-------------------------------------------------------------------------------01-13-2004 XREF 100% PENALTY

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PA YMENT,

ASSESSMENT

DATE (23C, RAC 006 )

84-1458582

941 199909
1040 200012
13,103.73

04-15-2001 OVERPAID CREDIT APPLIED
06-14-2004 .INTEREST ABATED

53.95-

06-14-2004 OVERPAYMENT CLEARED
06-14-2004 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM 11-14-2003 Statutory Notice of Balance Due

(0.01)

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 20 of 25

CERTIFICATE OF ASSESSMENTS, PAYMENTS, AND OTHER SPECIFIED MATTERS -------------------------------------------------------------------------------DAVID SUNSH INE

E IN/SSN:

FORM: CVPN TAX PER IOD: SEPT 1999
BALANCE

TYPE OF TAX: CIVIL PENALTY

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

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 SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

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

o .00

:: ::::::: - :: -:::::: ~::: -:::: ::: ~~~- ~ ~- ~ ~ ~~~ - - - - - - - - - - - - - - - -PRINT NAME: Linda L. Drake
TITLE:
DELEGATION ORDER:
Supervisor AccountinQ Technician, OQden W&I Submission Processing

SW Deleqation Order 198

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 10/21/2005

FORM 4340 (REV. 01-2002)

PAGE

3

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 21 of 25

United States

of America

Department of the Treasury

Internal Revenue Service
Date: August l7, 2005

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a true Form 4340,

Assessments, Payments and Other

Specified Matters for David Sunshine, SSN:
December 3 i, i 999, consisting of four pages

2, for Civil Penalty, for tax period

unaer 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:

-

Catalog Number 19002E

Il

.. EXHIBIT .;

Linda L. Drake Supervisor Accounting Technician Ogden SB/SE Submission Processing SW Delegation Order 198

~;~cx,~
Form 2866 (Rev. 09-1997)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 22 of 25

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

CERT IF I CA TE OF ASSESSMENTS , PAYMENTS, AND OTHER SPEC IF lED MATTERS

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

DAVID SUNSHINE EIN/SSN:
FORM: CVPN TAX PERIOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

EXPLANATION OF TRANSACTION

- - - - -- --- - - - - --- -- - - - - - - - - - --- - - - - - -- - - - - - - -- - - - - - - - ---- - - - -- - - - - - - - - - - - ---- - - -PROMPT ASSESSMENT IRC 6672 - TRUST FUND
RECOVERY PENAL TY

ASSESSMENT, OTHER DEBITS (REVERSAL)

PAYMENT,

ASSESSMENT

(REVERSAi)

CREDIT

DATE (23C, RAC 006 )

155,616.32

11-14-2003

29251-318-14502-3
PROMPT ASSESSMENT

29251-318-14502-3
200350

o . 00

11-14-2003
12-22-2003
100.00

INTEREST ASSESSED

649.36

01-13-2004 SUBSEQUENT PAYMENT MISCELLANEOUS PAYMENT
02-09-2004 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM

01-05-2004 RECEIVED POA/TIA
01-13-2004 MISCELLANEOUS PENAL TY
ADJUSTMENT

100.00-

IRC 6672 TRUST FUND

RECOVERY PENAL TY /RELATED PERSONAL CREDIT 83254-441- 530 66-4

12-22-2003 XREF 100X PENALTY

99912
PAGE
1

FORM 4340 (REV. 01-2002)

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 23 of 25

CERT IF I CA TE OF ASSESSMENTS , PAYMENTS, AND OTHER SPEC I F I ED MATTERS

DAVID SUNSHINE EIN/SSN:
FORM: CVPN TAX PERIOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENAL TY

EXPLANATION OF TRANSACTION

ASSESSMENT, OTHER DE BITS (REVERSAL)

CREDIT (REVERSAL)

PAYMENT,

ASSESSMENT

DATE (23C, RAC 006 )

12-22-2003 XREF 100~ PENAL TV

84 -1458582

941 199912
1040 200012
16,530.94
0.24

04-15-2001 OVERPAID CREDIT APPLIED
05- 31- 20 0 4. INTEREST OVERPAYMENT
CRED I T

1040 200012

06-28-2004 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM

07-05-2004 MODULE IN FEDERAL PAYMENT LEVY PROGRAM
08-20-2004 FEDERAL TAX LIEN

09-13-2004 FEES AND COLLECTION COSTS
09-27-2004 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM

42.00

06-21-2004 MISCELLANEOUS PENALTY
ADJUSTMENT

1,500.00-

IRC 6672 TRUST FUND

RECOVERY PENAL TY /RELA TED PERSONAL CRED I T

83254- 665- 530 29-4

FORM 4340 (REV. 01-2002)

PAGE

2

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 24 of 25

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

CERT IF ICA TE OF ASSESSMENTS , PAYMENTS, AND OTHER SPEC I F lED MATTERS

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

DAVID SUNSHINE EIN/SSN:
FORM: eVPN TAX PERIOD: DEe 1999
DATE

TYPE OF TAX: CIVIL PENAL TY

DATE (23C, RAe 006 ) (REVERSAi) - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - --EXPLANATION OF TRANSACTION
CREDIT

ASSESSMENT, OTHER DEBITS (REVERSAL)

PAYMENT,

ASSESSMENT

08-08-2005 LEGAL SUIT PENDING
11-14-2003 Statutory Notice of Balance Due

FORM 4340 (REV. 01-2002)

PAGE

3

Case 1:05-cv-00773-EJD

Document 13-13

Filed 01/26/2006

Page 25 of 25

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

CERT IF I CA TE OF ASSESSMENTS, PAYMENTS, AND OTHER SPEC IF I ED MATTERS

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

DAVID SUNSHINE EIN/SSN:
FORM:- CVPN - -- - -- PERIOD: -DEC- 1999- - - - - - - - - - - - - - - - - - - - - - --- -- - - - - - - - - - - - - - - -TAX - - - - - - - - - - - - -- - - - - --- -- - - - BALANCE

TYPE OF TAX: CIVIL PENALTY

138,076.50

AND AL L ASSESSMENTS , ABATEMENTS, CRED I TS, REFUNDS, AND ADVANCE OR UN IDENT I FlED PA YMENTS, AND THE ASSESSED BALANCE RE LA T I NG THERETO, AS DISCLOSED BY THE

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -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,

RECORDS OF TH I S OFF I CE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THERE IN. I FURTHER CERT I FY THAT THE OTHER SPEC I F I ED MATTERS SET FORTH IN TH IS TRANSCR IPT
APPEAR IN THE OFF ICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

:: ::: :::: -:: - ::::: :~~n~~ -~:;r~~:2A-JJ~- ~ -;X --Z - - - - - - - - - - - - - - - - - -PRINT NAME:
TITLE:
DELEGATION ORDER:
Supervisor Accounting Technician, Ogden SB/SE Submission Processing

SW Delegation Order 198

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 08/17/2005

FORM 4340 (REV. 01-2002)

PAGE

4