HomeMy WebLinkAbout11-8513Form 668 (Y)(c)
(Rev. February 2004)
Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 826680111
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As provided by section 6321, 6322, and 6323 of the Internal Revenue /I ' ?-?? 3 l=
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. C') ?.?
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Name of Taxpayer JERALD L METCALF -
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Residence 43 BURGNERS MILL RD -C p
CARLISLE, PA 17015 Cp --fp
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, p
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)
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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
6672 12/31/2009 XXX-XX-0082 04/04/2011 05/04/2021 4983.86
6672 03/31/2010 XXX-XX-0082 04/04/2011 05/04/2021 12541.06
6672 06/30/2010 XXX-XX-0082 04/04/2011 05/04/2021 20607.17
Place of Filing
Department of the Treasury - Internal Revenue Service
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 3 813 2 . 0 9
This notice was prepared and signed at
the 04th day of November
DETROIT, MI
2011
, on this,
Signature Title
REVENUE OFFICER 22-06-1411
for DREW N DELENICK -5?4 (717) 777-9619
(NOTE: Certific:lte of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-46vi. 1971 - 9 C.R. 409)
Form 668(Y)(c) (Rev. 2-2004)
Part I -Kept By Recording Office
CAT. NO 60025X