HomeMy WebLinkAbout09-3584Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien r) 9- 3 5 P V F T L
Area: Serial Number For Optional Use by Recording Office
D AREA #2
nes
F *19. vfl
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913-6050
(800)
Lien Unit Pho 550318509 d.
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As provided by section 6321, 6322, and 6323 of the Internal Revenue ct 3F93
Code, we are giving a notice that taxes (including interest and penalties) 1 s, 9 Z"'
have been assessed against the following-named taxpayer. We have made
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 rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. 7
Name of Taxpayer JEFFREY G HAYES ?- -''
Residence 8 DICKINSON AVE APT D
-T,
CAMP HILL, PA 17011-5415
RTANT RELEASE INFORMATION: For each assessment listed below, ?J1
notice of the lien is refiled by the date given in column (e), this notice shall,
E
day following such date, operate as a certificate of release as defined
6325(a).
i
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) b) (c) (d) (e) (f)
1040 12/31/1999 XXX-XX-2485 04/13/2009 05/13/2019 1636.23
1040 12/31/2000 XXX-XX-2485 04/20/2009 05/20/2019 1628.38
1040 12/31/2001 XXX-XX-2485 04/27/2009 05/27/2019 2575.00
1040 12/31/2002 XXX-XX-2485 04/27/2009 05/27/2019 5689.17
1040 12/31/2008 XXX-XX-2485 03/02/2009 04/01/2019 623.00
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
the _ 21st day of May 2009
Total 1 $ 12151.7 8
, on this,
Signature ?- H I V`"?? Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(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)