HomeMy WebLinkAbout10-3796Form 668 (Y)(c)
(Rev. February 2004)
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) 829-3903
662118410 _
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As provided by section 6321, 6322, and 6323 of the Internal Revenue .!Q
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Code, we are giving a notice that taxes (including Interest and penalties) ._.
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have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, CK /aye
there is a lien in favor of the United States on all property and rights to Z y3336
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property belonging to this taxpayer for the amount of these taxes, and o
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additional penalties, interest, and costs that may accrue. c °
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Name of Taxpayer JUSTIN M KELLY 'au-? c--
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Residence 918 BRANDT AVE c? =` ?
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NEW CUMBERLND, PA 17070-1564 Mir ?
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NT RELEASE INFORMATION: For each assessment listed below,
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unless e of the lien is refiled by the date given in column (e), this notice shall,
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on the following su ch date, operate as a certificate of release as defined
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in IRC 5(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refil ing of Assessment
(a b) c (d (e (f)
1040 12/31/2007 XXX-XX-3032 05/26/2008 06/25/2018 3366.45
1040 12/31/2008 XXX-XX-3032 12/07/2009 01/06/2020 10713.57
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 14080.02
This notice was prepared and signed at
the 01st day of June
DETROIT, MI
2010
, on this,
tle
Signature A 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) Form 66SM(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X