HomeMy WebLinkAbout10-6369Form 668 (Y)(c)
IRev. February 2004)
11883
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 704557110 /D 6 _ 36?
C? JCT[_
As provided by section 6321, 6322, and 6323 of the Internal Revenue 7
l
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 G ,n
property belonging to this taxpayer for the amount of these taxes, and -o r...a j-VA
additional penalties, Interest, and costs that may accrue.
Name of Taxpayer THADDEY L & DARLENE L CHAMBERLIN n- I.s
Residence 103 LEWISBERRY RD
NEW CUMBERLND, PA 17070-2418 ca
r
ANT RELEASE INFORMATION: For each assessment listed below,
ice of the lien is refiled by the date given in column (e), this notice shall,
F d
?
y following such date, operate as a certificate of release as defined DO
, ?
?q' fo
25(x).
IRC y 7
Tax Period Date of L ast Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2004 XXX-XX-5370 05/30/2005 06/29/2015 11707.94
1040 12/31/2007 XXX-XX-5370 02/09/2009 03/11/2019 12208.44
1040 12/31/2008 XXX-XX-5370 07/27/2009 08/26/2019 10739.57
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 34655.95
This notice was prepared and signed at DETROIT, MI
the 28th day of September 2010
, on this,
Signature Yk, C Title
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) Form 668(Y)(e) (Rev. 2-2004)
Part I -Kept By Recording Office CAT. NO 60025X