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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004)
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050
802201911
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
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. )5
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Name of Taxpayer JOHN M DALTON t"
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Residence PO BOX 1112
CARLISLE, PA 17013-0000 .
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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, _
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on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). ?
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Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refilling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2006 XXX-XX-6028 09/13/2010 10/13/2020 20142.92
1040 12/31/2007 XXX-XX-6028 09/13/2010 10/13/2020 18800.69
1040 12/31/2008 XXX-XX-6028 03/14/2011 04/13/2021 13762.18
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 52705.79
This notice was prepared and signed at DETROIT, MI
the 21st day of July 2011
, on this,
Signature Title
«` REVENUE OFFICER 22-08-4015
for PATRICIA REUTER- N (610) 898-2921
(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 1 - Kept By Recording Office CAT. NO 60025X