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