HomeMy WebLinkAbout11-1030Form 668 (Y)(c)
(Rev. February 2004)
1
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
WAGE .& INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650 745008811 ® r-!
103 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 following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, -n
there is a lien In favor of the United States on all property and rights to ?c s-
property belonging to this taxpayer for the amount of these taxes, and n
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additional penalties, interest, and costs that may accrue. +
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Name of Taxpayer ROBERT L SHELLENBERGE --shy
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Residence 211 WOOD ST
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CAMP HILL, PA 17011-2640 rv
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).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e)
1040 12/31/2004 XXX-XX-0413 01/05/2009 02/04/2019 2245.82
1040 12/31/2005 XXX-XX-0413 01/05/2009 02/04/2019 8214.07
1040 12/31/2006 XXX-XX-0413 07/20/2009 08/19/2019 8687.47
1040 12/31/2007 XXX-XX-0413 04/12/2010 05/12/2020 13417.97
Place of Filing
Prothonotary
Cumberland County Total $ 32565.33
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
, on this,
the 20th day of January 2011.
Signature Title
ACS 11-00-0000
for DEBRA K. HURST -4 (800) 829-7650
(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)(c) (Rev. 2-2004)
Part 1 • Kept By Recording Office CAT. NO 60025X