HomeMy WebLinkAbout11-4181Form 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) 913-6050 781539411 /?/?/
-'
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 _
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 --O:K
property belonging to this taxpayer for the amount of these taxes, and oo ? r
additional penalties, interest, and costs that may accrue. "n
Name of Taxpayer BARTON W SHIVELY
..5? 1 CD
:
C_ 331-
may
,.- -
Residence 421 W KELLER ST
MECHANICSBURG, PA 17055-3732
IMPO
NT RELEASE INFORMATION: For each assessment listed below,
unless e of the lien is refiled by the date given in column (e), this notice shall,
: e(
da
on the following su ch date, operate as a certificate of release as defined
in IRC 5(a). 4'0fl a !ji? y'?S
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment RefIRng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2006 XXX-XX-4787 04/11/2011 05/11/2021 1806.74
1040 12/31/2009 XXX-XX-4787 04/04/2011 05/04/2021 1077.56
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 2884.30
This notice was prepared and signed at
the _ 29th day of April
Signature
DETROIT, MI
, on this,
2011
Title
REVENUE OFFICER
22-06-1413
for LINDSEY O BOWLIN (717) 777-9623
(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.R. 4091
Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT, NO 60025X