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Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
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 772386611
As provided by section 6321, 6322, and 6323 of the Internal Revenue OIL
Code, we are giving a notice that taxes (including Interest and penalties) 'T
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, 12 0? S8U0 (?
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 o n
additional penalties, Interest, and costs that may accrue. n 3 = --i
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Name of Taxpayer RICKY L MOTTER Z = -O
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Residence 39 MOTTER DR < -?rl
SHIPPENSBURG, PA 17257-9734
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RTANT RELEASE INFORMATION: For each assessment listed below,
notice of the lien is refiled by the date given in column (e), this notice shall,
E
day following such date, operate as a certificate of release as defined
o
inR
6325(a).
Tax Peri
od
Date of
Last Day for
Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2003 XXX-XX-6527 04/05/2010 05/05/2020 12311.07
1040 12/31/2008 XXX-XX-6527 01/03/2011 02/02/2021 20230.16
1040 12/31/2009 XXX-XX-6527 05/31/2010 06/30/2020 8850.11
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 41391.34
This notice was prepared and signed at
DETROIT, MI
the 01st day of April 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)
Part 1 - Kept By Recording Office CAT. 668(lt (Rev. 2-2004)
CAT. NO 60025X