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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(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) 829-3903 753253211
As provided by section 6321, 6322, and 6323 of the Internal Revenue It-.2
TCr
061
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, = Tip
there is a lien in favor of the United States on all property and rights to rna - -?
property belonging to this taxpayer for the amount of these taxes, and CO
additional penalties, interest, and costs that may accrue.
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Name of Taxpayer JOHN T SMITH JR r-:7
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Residence 935 FACTORY ST D r R
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CARLISLE, PA 17013-1354 0 =3
NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiied by the date given in column (e), this notice shall,
F
following such date, operate as a certificate of release as defined
12
5(a). 5S V 3,5
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 12/31/2003 XXX-XX-6174 05/05/2008 06/04/2018 21471.39
1040 12/31/2004 XXX-XX-6174 02/23/2009 03/25/2019 13943.38
1040 12/31/2005 XXX-XX-6174 02/23/2009 03/25/2019 13971.44
1040 12/31/2006 XXX-XX-6174 02/23/2009 03/25/2019 13029.89
1040 12/31/2007 XXX-XX-6174 04/12/2010 05/12/2020 11395.23
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 73811.33
This notice was prepared and signed at
the 11th day of February
DETROIT, MI
2011
, on this,
Signature Title
ACS SBSE 22-00-0001
for FRED BANKS (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) Form 668(Y)(c) (Rev. 2-2004)
Part i - Kept By Recording Office CAT. NO 60025X