HomeMy WebLinkAbout11-0669Form 668 (Y)(c)
(Rev. 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) 913-6050 742678711
As provided by section 6321, 6322, and 6323 of the Internal Revenue -?3
Code, we are giving a notice that taxes (including interest and penalties) rnw
C- rn-n
have been assessed against the following-named taxpayer. We have made z? Me r
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 r _.?
property belonging to this taxpayer for the amount of these taxes, and 30. o-n
additional penalties, interest, and costs that may accrue.
additional 0 =-
Name of Taxpayer KENNIE M JAMISON SR DECD O
LOUISE JAMISON
Residence 106 VIRGINIA AVE
CARLISLE, PA 17013-1072
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). L D -;L3
Tax Period Date of Last Day for Unpaid Ba lance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2003 XXX-XX-0165 03/01/2004 03/31/2014
1040 12/31/2003 XXX-XX-0165 02/20/2006 03/21/2016 1528.09
1040 12/31/2004 XXX-XX-0165 05/30/2005 06/29/2015 86.76
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 1614.85
This notice was prepared and signed at
the 13 th day of January
DETROIT, MI
2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1413
for LINDSEY 0 BOWLIN (717) 777-9623
(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( (Rev. 1
Part 1 - Kept By Recording Office CAT. NO 60025X
CAT
025X
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