HomeMy WebLinkAbout09-5105Form 668 M(c)
(Rev. February 2004)
6152
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lied- TLt? ?;?
Area: Serial Number For Optional Use by R@d6
SMALL BUSINESS/SELF EMPLOYED AREA #2 Q9 vlvi_ 27 PIL'I 2: 31
Lien Unit Phone: (800) 913-6050 565523809
As provided by section 6321, 6322, and 6323 of the Internal Revenue
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 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.
of Taxpayer
Residence 206B UMBERTO ST
NEW CUMBERLAND, PA 17070
Office
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s I y. o? p?
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).
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Tax Period Date of Last Day for
Kind of Tax Ending Identifying Number Assessment Refilling
(a) (b) (c) (d) (e)
1040 12/31/2005 XXX-XX-1963 112/08/20081 01/07/2019
Place of Filing
Prothonotary
Cumberland County
rnrliRTe. PA 17013
8551.39
Total 1 $ 8551.39
This notice was prepared and signed at DETROIT, MI
, on this,
the 15th day of July 2009
Signature A ATitle
12-00-0000
CS
for DEBRA K. HURST (800) 829-7650
Unpaid Balance
of Assessment
(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 66SM(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X