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Department of the Treasury - Internal Revenue Service
Form 668 (2)04) Notice of Federal Tax Lien T
(Rev. February 2004) 7?1?,. 09 - 319.9-Z ? I L
A Serial Number For Optional Use by Recording Office
rea:
SMALL BUSINESS/SELF EMPLOYED AREA #2 eJ9
Lien Unit Phone: (800) 913-6050 554138909 ??
As provided by section 6321, 6322, and 6323 of the Internal Revenue Ck
Code, we are giving a notice that taxes (including interest and penalties)
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 alien in favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and C C= o
additional penalties, interest, and costs that may accrue.
rr, C=
Name of Taxpayer KIMBERLY L MARTIN = r-
G
Residence 5230 S IMPSON FERRY RD t _?
MECHANICSBURG, PA 17050-3514 tv?
RTANT RELEASE INFORMATION: For each assessment listed below,
notice of the lien is refiled by the date given in column (e), this notice shall,
F
day following such date, operate as a certificate of release as defined
6325(x).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refsung of Assessment
(a) b c) d e f)
941 06/30/2008 23-2941949 10/06/2008 11/05/2018 3545.36
941 09/30/2008 23-2941949 12/22/2008 01/21/2019 10062.64
941 12/31/2008 23-2941949 03/02/2009 04/01/2019 8871.63
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $
This notice was prepared and signed at
the 05th day of June
DETROIT, MI
22479.63
2009
, on this,
Signature A Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(ROTE: 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 669M(c) (Rev. 2-2004)
Part I - Kept By Recording Office CAT. NO 60025X