HomeMy WebLinkAbout10-0076Form 668 (Y)(c)
(Rev. February 2004)
4804
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 611178309
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) q/?,
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, L L
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
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Name of Taxpayer WILLIAM H RIVELY
Residence 135 S 32ND ST
CAMP HILL, PA 17011-5101
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
o
n I 6325(a).
i
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refili ng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX-XX-8006 09/21/2009 10/21/2019 616.12
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 616.12
This notice was prepared and signed at
the 24th day of December
DETROIT, MI
2009
, on this,
Signature Title
ACS 12-00-0000
for DEBRA K. HURST (800) 829-7650
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rui. 71-466, 1971 - 2 C.B. 409) Part 1 - Kept By Recording Office CAT. 668( (Rev. 2 2004)
CAT. NO 60025X