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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien 4m-w-lerm
(Rev. February 20041 i 0 _ U 78 Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
637781810
$1Q.00 P(N PLFr
Asrovided by section 6321, 6322, and 6323 of the Internal Revenue GL`s alor5
Co e, we are giving a notice that taxes (including interest and penalties) a13no9
have been assessed against the following-named taxpayer. We have made
a d mand for payment of this liability, but it remains unpaid. Therefore,
the a is a lien in favor of the united States on all property and rights to
pro erty belonging to this taxpayer for the amount of these taxes, and
ad itional penalties, interest, and costs that may accrue.
- ;
Nam of Taxpayer ERNEST R & KAREN D JOHNSON '
M
1 l ?
Residence 447 LEWISBERRY RD APT D ,
NEW COMBERLAND, PA 17070-2340 c' --
NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
E
following such date, operate as a certificate of release as defined
5(a).
RC
Tax Period Date of Last Day fo r Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
040 12/31/2008 XXX-XX-4660 06/22/2009 07/22/2019 524.53
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 524.53
This notice was prepared and signed at
the 25th day of March
DETROIT, MI
2010
on this,
Signature A .PQ 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)
Part 1 - Kept By Recording Office CAT. 668( (Rev. 2 2004)
CAT. NO 60025X