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Department of the Treasury - Internal Revenue ervice
Form 668 (Y
Notice of Federal Tau Lien
I
(Rev. February 2004) 04) C I
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 813397911 /1 /
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*
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 o
additional penalties, interest, and costs that may accrue. r
Name of Taxpayer PETER M & KATHRYN A STAGGS zM r*t M M =c _n
_VM
Residence 65 JAMESTOWN RD A -°
SHIPPENSBURG, PA 17257-9148 -C--) b.
IMPORTANT RELEASE INFORMATION: For each assessment listed below, '-+ s
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). W ? yea
Tax Period Date of Last Day fo Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2009 XXX-XX-9648 11/15/2010 12/15/2 ;20 71930.35
Place of Filing
Prothonotary
Cumberland County T otal $ 71930.35
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 09th day of September 2011
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 vali ity 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