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Department of the Treasury - Internal Revenue Service
Form 668 ( Notice of Federal Tax Lien
(Rev. February 2 2004) 004)
A Serial Number For Optional Use by Recording Office
rea:
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650
617546710
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As provided by section 6321, 6322, and 6323 of the Internal Revenue 9.04) -Ccr
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Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made /lQBY
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 ?-r` a23L71,,3
additional penalties, interest, and costs that may accrue.
Name of Taxpayer ROSS DEYOUNG
Residence 30 S 24TH ST
CAMP HILL, PA 17011-4608
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 D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Re filing of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2003 XXX-XX-5869 08/04/2008 09/03/2018 9582.41
N
V
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Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 9582.41
This notice was prepared and signed at DETROIT, MI
, on this,
the 19th day of January 2010
Signature A. `y?itic Title
ACS 11-00-0000
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. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X