HomeMy WebLinkAbout09-5828Form 668 (Y)(c)
(Rev. February 2004)
15
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien 72a a g _ T P2.? ):?'rZ-
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 n
4
9 '"'00
Lien Unit Phone: (800) 829-3903 573203809 4
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As provided by section 6321, 6322, and 6323 of the Internal Revenue C S'y ? J.-
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.
Name of Taxpayer SCOTT G CHAPMAN
Residence 111 HOLLY DR
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MECHANICSBURG, PA 17055-5527
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77,rr:
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NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
F
following such date, operate as a certificate of release as defined n?
5(a).
IRC
Tax Period Date of Last Day fo r Unpaid Balance
Kind of Tax Ending, Identifying Number Assessment Refilng of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2005 XXX-XX-2417 06/12/2006 07/12/2016
1040 12/31/2005 XXX-XX-2417 07/30/2007 08/29/2017 3597.01
1040 12/31/2007 XXX-XX-2417 06/02/2008 07/02/2018 2031.87
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 5628.88
This notice was prepared and signed at
DETROIT, MI
the 14th day of August 2009
, on this,
Signature H ACS 22-00-0008
for MICHAEL W. COX (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 Recording Office CAT. NO 60025X