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Department of the Treasury - Internal Revenue Service
Form 668 (20(4)
(Rev. February 2004) Notice of Federal Tax Lien 3 F rt-
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 1
Lien Unit Phone: (800) 913-6050 602744609
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 .2 3y 93
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 n Q ;0
property belonging to this taxpayer for the amount of these taxes, and = a -?
additional penalties, interest, and costs that may accrue. r ! _ ? rnm
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Name of Taxpayer KIMBERLY L MARTIN •-' -a?
Residence 5234 SIMPSON FERRY RD y(_ N 'ern
MECHANICSBURG, PA 17050-3514 Z= -ct1
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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 Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
941 03/31/2008 23-2941949 06/02/2008 07/02/2018 6391.20
941 06/30/2009 23-2941949 08/31/2009 09/30/2019 1970.46
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 8361.66
This notice was prepared and signed at
DETROIT, MI
the 30th day of November 2009
, on this,
Signature )? f \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)
Part 1 - Kept By Recording Office Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X