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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(Rev. February 2004) 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 746393911 11-
1
31
1
,
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, =m ran r-.-
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
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additional penalties, interest, and costs that may accrue. C
230 CD
Name of Taxpayer THOMAS P & LOIS A SHULTZ
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Residence
63 GREENMONT DRIVE
ENOLA, PA 17025
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
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in IRC 6325(a).
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Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refilling Unpaid Balance
of Assessment
(a) (b) (c) d) (e) (f)
1040 12/31/2007 XXX-XX-5894 11/10/2008 12/10/2018 4114.03
1040 12/31/2009 XXX-XX-5894 06/07/2010 07/07/2020 88 15.48
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total I$ 12929.51
This notice was prepared and signed at - DETROIT, MI
the 24th day of January 2011
, on this,
Signature Title
ACS SBSE 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)
Part 1 - Kept By Recording Office CAT. 668( (Rev. 2-2004)
CAT. NO 60025X
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