HomeMy WebLinkAbout09-4357Form 668 (Y)(c)
(Rev. February 2004)
4804
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien .yL 09- 4357 c 7-Z
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050
558399109 /?
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As provided by section 6321, 6322, and 6323 of the Internal Revenue C? q"2- 0 4
Code, we are giving a notice that taxes (including Interest and penakies)
have been assessed against the following-named taxpayer. We have made 2 _ 7 3 30
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. ,
x
Name of Taxpayer CHAD A BEAR
a: 1D
s
Residence 212 E MAIN ST
SHIREMANSTOWN, PA 17011-6316
c.n
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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 Way for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Wiling of Assessment
(a) (b) (c) (d) (e) f)
1040 12/31/2006 XXX-XX-0779 06/01/2009 07/01/2019 248.53
1040 12/31/2007 XXX-XX-0779 05/18/2009 06/17/2019 1095.83
1040 12/31/2008 XXX-XX-0779 05/18/2009 06/17/2019 2434.81
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 3779.17
This notice was prepared and signed at
the 18th day of June
DETROIT, MI
2009
, on this,
Signature ?- H -Y?? 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 660(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X