HomeMy WebLinkAbout09-5951Form 668 (Y)(c)
(Rev. February 2004)
2447
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 574320409 09
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 CK-A
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. R oZ 3 Dw
Name of Taxpayer KIMBERLY L MARTIN l
Residence 5230 SIMPSON FERRY RD
MECHANICSBURG, PA 17050-3514
RELEASE INFORMATION: For each assessment listed below,
f the lien is refiled by the date given in column (e), this notice shall,
F
7
llowing such date, operate as a certificate of release as defined
in
6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref illing of Assessment
(a) (b) (c) (d) ( e) (f)
941 03/31/2009 23-2941949 06/29/2009 07/29/2019 10603.65
n N
?' iJ
-77!%
f lT
t t? ; ?~a
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 10603.65
This notice was prepared and signed at DETROIT, MI
the 19th day of August 2009
, on this,
Signature A 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)
Part 1 -Kept By Recording Office CAT. NO 60025X