HomeMy WebLinkAbout07-4851Form 668 (Y)(c)
(Rev. February 2004)
3477
Department of the Treasury -Internal Revenue Service
Notice of Federal Tax Lien .~,~~ ~ ,~ . Y ~,S~l F rrr.
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 n~ n
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Lien Unit Phone: (800) 913-6050 382897907 ~
As provided by section 632 f, 6322, and 6323 of the Internal Revenue ~~ I G L 3d
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made ~~~ „ % /~G ~~j
a demand for payment of this liability, but it remains unpaid. Therefore,
there is a lien in favor of the United States on all property and rigfits to c5 ^~
property belonging to this taxpayer for the amount of these taxes, and ~ y ~
additional penalties, interest, and costs that may aurae. T' "~" ~
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Name of Taxpayer CLYDE L BERTMAN _ G' ~~~
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Residence 1400 BENT CREEK BLVD APT 217
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MECHANICSBURG, PA 17050 =='
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IMPORTAAIT RELEASE INFORMATION: For each assessment listed below, .
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unless notice of the lien is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Dayy for Unpaid Balance
.Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a (b) (c) (d) (e)
1040 12/31/2005 XXX-XX-0342 11/20/2006 12/20/2016 18054.94
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Tota! ~$ 18054.94
This notice was prepared and signed at
the 06th day of _ August
DETROIT, MI
2007
on this,
Signature ~ A ~Y2~~~%~',r ACS 22-00-0008
for REGINA OWENS (800} 829-3903
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part 1 -Kept By Rewrding O1PFice CAT. NO 60025X