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Form 668 (Y)(c)
(Rev. February 2004)
1883
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) 829-3903 826253011
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As provided by section 6321, 6322, and 6323 of the Internal Revenue 72-
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, c -f
there is a lien In favor of the United States on all property and rights to co
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property belonging to this taxpayer for the amount of these taxes, and •c M
additional penalties, interest, and costs that may accrue. > . C) ,
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Name of Taxpayer THADDEY L & DARLENE L CHAMBERLIN -
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Residence 103 LEWISBERRY RD = i .,?
NEW CUMBERLND, PA 17070-2418
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), this notice shall,
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on the day following such date, operate as a certificate of release as defined
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 12/31/2005 XXX-XX-5370 01/10/2011 02/09/2021 16502.60
1040 12/31/2006 XXX-XX-5370 12/27/2010 01/26/2021 12018.81
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 28521.41
This notice was prepared and signed at
the 03rd day of November
DETROIT, MI
2011
, on this,
Signature Title
ACS SBSE 22-00-0001
for FRED BANKS -4ff? (800) 829-3903
(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 6009Fx