HomeMy WebLinkAbout10-5236Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AEA #2
Lien Unit Phone: (800) 913-6050 683397910
As provided by section 6321, 6321 , and 6323 of the Internal Revenue
Code, we are giving a notice that es (including interest and penalties)
have been assessed against the folio ng-named taxpayer. We have made
a demand for payment of this liabili , but it remains unpaid. Therefore,
there is a lien in favor of the Unit States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and co sts that may accrue.
Residence 221 WALNUT STCARLISLE, PA,17013-3869
IMPORTANT RELEASE INFORMA
unless notice of the lien is refiled by the
on the day following such date, opera
in IRC 6325(a).
For Optional Use by Recording Office
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)N: For each assessment listed below,
to given in column (e), this notice shall, jq.oo r„[.
as a certificate of release as defined /
R? ? fl,SYD
Tax Per Date of
Kind of Tax Endingiod Identifring Number Assessment
(a (b) _ 1 (c) (d)
1040 12/31/2004 XXX-?XX-3373 07/12/2010
1040 12/31/2005 XXX±XX-3373 07/05/2010
Last D for Unpaid Balance
Rend of Assessment
(e) f)
08/11/2020 2133.96
08/04/2020 658.97
Place of Filing
Prothonotary
Cumberland County Total $ 2792.93
Carlisle, Phi 17013
This notice was prepared and signed at DETROIT, MI
, on this,
the 29th day of July 2010
Signature A p? Title
°"^N 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(1 1
Part 1 - Kept By Recording Office CAT. N NO O 60025X
CAT
025X