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Department of the Treasury - Internal Revenue Service
Form 668 M(c)
(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 750315911
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y section 6321, 6322, and 6323 of the Internal Revenue f0
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 co --n
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property belonging to this taxpayer for the amount of these taxes, and _VM
additional penalties, interest, and costs that may accrue. ,
Name of Taxpayer ARLEEN B MILLER -n
ABMILLER INSURANCE AGENCY ' 21
Residence 2515 MARKET ST
CAMP HILL, PA 17011-4630
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 followin
such date
erate a
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ease as defined
in IRC 6325(a). ,/? ems` a j sd3
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Da for
Refiling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (f)
941 09/30/2009 25-1729840 11/30/2009 12/30/2019 2531.08
941 12/31/2009 25-1729840 03/01/2010 03/31/2020 3160.63
941 03/31/2010 25-1729840 05/24/2010 06/23/2020 1029.56
941 06/30/2010 25-1729840 08/30/2010 09/29/2020 3967.98
941 09/30/2010 25-1729840 11/29/2010 12/29/2020 1927.23
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 12616.48
This notice was prepared and signed at
DETROIT, MI
the 03rd day of February 2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1411
for DREW N DELENICK (717) 777-9619
(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 20041
CAT. NO 60025X