HomeMy WebLinkAbout11-3981Form 668 (Y)(c)
(Rev. February 2004)
11883
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) 913-6050 778377611 // - .3? C7L
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77 /
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 c Q
a demand for payment of this liability, but It remains unpaid. Therefore, -a z = -+
there is a lien in favor of the united States on all property and rights to zrn -0 rn-
xpayer
? taxes, and
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Name of Taxpayer J GOURLEY cD -
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Residence 3B ROUND RIDGE RD - 5C
MECHANICSBURG, PA 17055-9211
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 as defined
in IRC 6325(a) /
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Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) W
1040 12/31/2007 XXX-XX-5777 02/28/2011 03/30/2021 19290.16
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 19290.16
This notice was prepared and signed at
the _ 20th day of April
DETROIT, MI
2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN
(717) 777-9624
4!%? 41"
(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 Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X