HomeMy WebLinkAbout11-7195 5226
Department of the Treasury - Internal Revenue S rvice
Form 668 (Y)(c)
Notice of Federal Tax Lien
(Rev. February 2004)
A Serial Number For O ptional Use by Recording Office
rea:
SMALL BUSINESS/SELF EMPLOYED AREA #7
Lien Unit Phone: (800) 913-6050 813727911
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As provided by section 6321, 6322, and 6323 of t
Code, we are giving a notice that taxes (including interest and penalties) z?
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, mcO cn rn
there is a lien in favor of the united States on all property and rights to =M rn
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property belonging to this taxpayer for the amount of these taxes, and
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additional penalties, interest, and costs that may accrue. r-= -I
Name of Taxpayer DAVID BERRIOS
?C-11 MIR
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Residenc
611 HERMAN AVE # 2D
LEMOYNE, PA 17043-1824
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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unless notice of the lien is refiled by the date given in column (e), t 1g ?,4(,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Day for ! unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2009 XXX-XX-8763 05/23/2011 06/22/20 .1 232.56
Place of Filing
Prothonotary
Cumberland County Total $ 232.56
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 09th day of September, 2011
Signature Title
ACS W&I
11-00-0000
for DEBRA K. HURST (800) 829-7650
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the val dity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office CAT. 668( (Rev. 2-2004)
CAT. NO 60025X
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