HomeMy WebLinkAbout12-0406 11883
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 #3
Lien Unit Phone: (800) 913-6050 840563512
As provided by section 6321, 6322, and 6323 of the Internal Revenue & /E?-- ?G
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
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additional penalties, interest, and costs that may accrue.
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Name of Taxpayer SAMUEL W SKIRBOLL ?? -, -,
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Residence
442 CRESTVIEW CT
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CAMP HILL, PA 17011 XC?11 --°°
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NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
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following such date, operate as a certificate of release as defined
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Tax Period Date of Las t 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-0602 11/21/2011 12/21/2021 1536.94
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 1536.94
This notice was prepared and signed at DETROIT, MI
the 06th day of January 2012.
, on this,
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 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 60025X