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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 759118511
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As provided by section 6321, 6322, and 6323 of the Interna
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, =3
there is a lien in favor of the united States on all property and rights to u = :;
property belonging to this taxpayer for the amount of these taxes, and -- ;
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additional penalties, interest, and costs that may accrue. ti "o :Na r
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Name of Taxpayer DUSTIN DANNER '
Residence 1156 CENTERVILLE RD
NEWVILLE, PA 17241-9554 F;
NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refilled by the date given in column (e), this notice shall,
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following such date, operate as a certificate of release as defined
IRC
5(a). .7
Tax Period Date of Last Day fo r Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX-XX-1635 06/15/2009 07/15/2019 3552.66
1040 12/31/2009 XXX-XX-1635 05/31/2010 06/30/2020 6663.54
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 10216.20
This notice was prepared and signed at DETROIT, MI
the 24th day of February 2011
, on this,
Signature Title
ACS SBSE 22-00-0001
for FRED BANKS 22 (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( Nev. 2 20041
CAT. NO 60025X
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