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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
A Serial Number For Optional Use by Recording Office
rea:
SMALL BUSINESS/SELF EMPLOYED AREA #2 r-a
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Lien Unit Phone: (800) 913-6050 675740610 o
As provided by section 6321, 6322, and 6323 of the Internal Revenue /Q - 1/7G?r -; 5
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
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 ;-
additional penalties, interest, and costs that may accrue.
Name of Taxpayer DANIEL A HASKINS
Residence 1705 ELM ST
NEW CUMBERLND, PA 17070-1222
F RTANT RELEASE INFORMATION: For each assessment listed below,
notice of the lien is refiled by the date given in column (e), this notice shall,
fq, pd . "U;40ft4e4
e day following such date, operate as a certificate of release as defined
6325(a). ?C
Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) d) e)
1040 12/31/2004 XXX-XX-8154 11/17/2008 12/17/2018 25454.93
1040 12/31/2005 XXX-XX-8154 11/09/2009 12/09/2019 23424.65
1040 12/31/2006 XXX-XX-8154 11/09/2009 12/09/2019 57846.86
1040 12/31/2007 XXX-XX-8154 04/05/2010 05/05/2020 11799.87
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 118526.31
This notice was prepared and signed at
DETROIT, MI
the 08th day of July 2010
, on this,
Signature A Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(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