HomeMy WebLinkAbout10-5237Form 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 AREA #1
Lien Unit Phone: (800) 913-6050 684347010
For Optional Use by Recording Office
10-5:07 r--r(--
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 fol ng-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.
ame of Taxpayer
Residence 512 POPLAR CHgUCH RD
CAMP HILL, PA'',17011
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).
pdD fd- POx?°.? \Y`gf"us
Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identif.Ang Number Assessment Refing of Assessment
(a) (b (c) d (e
1040 12/31/2004 XXX4XX-0935 11/10/2008 12/10/2018 2084.31
1040 12/31/2005 XXX-IXX-0935 11/02/2009 12/02/2019 4946.05
1040 12/31/2006 XXX4XX-0935 11/02/2009 12/02/2019 4946.05
1040 12/31/2007 XXX-4X-0935 02/08/2010 03/09/2020 5988.99
1040 12/31/2008 XXX-XX-0935 11/23/2009 12/23/2019 4689.35
Place of Filing
Prothonotary
Cumberland County
Carlisle, P4 17013
Total J$ 22654.75
This notice was prepared and signed at
the 30th day of July i
DETROIT, MI
2010
, on this,
Signature A Title
ACS 12-00-0000
for DEBRA K. HURST (800) 829-7650
(NME: 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