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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
IRev. February 2004, Notice of Federal Tax Lien ~~ _ 3i~o FTL.
Area: Serial Number For Optional Use by Recording Office
SMALL B[JSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
664534810
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As provided by section 6321, 6322, and 6323 of the Internal Revenue ~~ 105'78
Code, we are giving a notice that taxes (including interest and penalties) ~~ a'Fs597
have been assessed against the following-named taxpayer. We have made n
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
property belonging to this taxpayer for the amount of these taxes, and _.-.
+ ~ ~ e - _r, ;
~,
additional penalties, interest, and costs that may accrue. _
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Name of Taxpayer JAY & YOLANDA ROTHENBERGER `' ~~.,
i-~, ~• -
t~ - _ ,
'4> t_ ...
Residence 217 CENTER ST ~ cr
ENOLA, PA 17025-2606 ";
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).
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Dayy for
Refiling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2004 XXX-XX-8116 10/22/2007 11/21/2017 6425.01
1040 12/31/2005 XXX-XX-8116 08/06/2007 09/05/2017 5229.48
1040 12/31/2006 XXX-XX-8116 09/01/2008 10/01/2018 7722.92
1040 12/31/2007 XXX-XX-8116 09/01/2008 10/01/2018 776.55
1040 12/31/2008 XXX-XX-8116 02/08/2010 03/09/2020 618.25
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 20772.21
This notice was prepared and signed at
the 08th day of June
DETROIT, MI
2010
on this,
Signature ~ ~i ~Y'~~ 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 2 -Internal Revenue Service TDA Copy Form 668(Y)(c) (Rev. 2-2004f
CAT. NO 60025X