HomeMy WebLinkAbout11-0431Form 668 (Y)(c)
(Rev. Fel)ruary 2004)
11883
Department of the Treasury Internal Revenue Service
Notice of Federal Tax: Lien
Area: Serial Number For Optional Use by Recording Office
WAGE & IMTESTMENT AREA #1
Lien Unit Phone: (800) 829-717650 74146 301.1 1
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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 following-named taxpayer. We have made m
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 -
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property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer DAVID BERRIOS '"o ?cn- -Z-?
Residence
611 HERMAN AVE ## 2D
,_.
LEMOYNE, PA 17043--1824
NT RELEASE INFORMATION; Far each assessment Iist:ecl F?elaw,
e of the lien is refiled by the date given in ralumn (e), this notice shalt,
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fallowing such date, operate as a certificate of release as defir+ed 5(
)
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Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31!2006 XXX-XX-8763 05/28,12007 06/27/2017 1758.82
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 1758.82
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This notice was prepared and signed at ........... ..............._...._D .. ETROI .
...................................................... _..............
.
ttte 11th dayof January , 2011,
, on this,
Signature Title
ACS 11-00-0000
for DEBRA K. HURST -4 *:? t800) 829-`7650
(NOTE: Certificate of officer authorized by law to take acknowledgmen is no essential U.) the validity of Notice of Federal Tax lien
Rev. Real. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part I - Kept By Recording Office CAT. NO 60025X