HomeMy WebLinkAbout10-4935Form 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 679819610 9X' A771
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As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the folbwing-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 n ;
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additional penalties, interest, and costs that may accrue.
Name of Taxpayer JERRY L OTT =--' ; -
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Residence 329 WALNUT DALE RD -
SHIPPENSBURG, PA 17257-9666
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NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
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following such date, operate as a certificate of release as defined
IRC
5(a). A4* o-W!010k
Tax Period Dateof Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment ReBling of Assessment
a) b c d e
1040 12/31/2006 XXX-XX-4921 06/04/2007 07/04/2017 4240.93
1040 12/31/2007 XXX-XX-4921 02/09/2009 03/11/2019 1660.02
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 5900.95
This notice was prepared and signed at DETROIT, MI
, on this,
the 20th day of July 2010
Signature A ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
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(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)(
Part 1 -Kept By Recording Ofnce c) (Rev. 2-2004)
CAT. NO 60025X