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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 818424911
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 c?
property belonging to this taxpayer for the amount of these taxes, and ?- -
o r
additional penalties, interest, and costs that may accrue. ; ....
rn
Name of Taxpayer MATTHEW S GAMBER cnrr-
Ss
Residence 1511 PENN STREET
HARRISBURG, PA 17102-2514
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). ifG f Vi
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2009 XXX-XX-2151 09/12/2011 10/12/2021 15314.09
6672 09/30/2009 XXX-XX-2151 07/26/2011 08/25/2021 2059.86
6672 12/31/2009 XXX-XX-2151 07/26/2011 08/25/2021 6204.42
6672 06/30/2010 XXX-XX-2151 07/26/2011 08/25/2021 7177.89
6672 09/30/2010 XXX-XX-2151 07/26/2011 08/25/2021 6091.59
6672 12/31/2010 XXX-XX-2151 07/26/2011 08/25/2021 2176.94
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$ 39024.79
This notice was prepared and signed at DETROIT, MI
the 03rd day of October 2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1408
for MIGNA RODRIGUEZ -4ff*zo!??4 (717) 777-9622
(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)
Pan i - Kept By Recording Office CAT. NO 60025X