HomeMy WebLinkAbout12-0414Form 668 (Y)(c)
(Rev. February 2004)
3460
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) 913-6050 840678512
As provided by section 6321, 6322, and 6323 of the Internal Revenue / 2 °
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 -s .., ;"
additional penalties, interest, and costs that may accrue.
-OM
Name of Taxpayer CARLA J DENTE CLARK rn c-- r` i=
? C i
Residence 9 SAND PINE CT > --j --4
MECHANICSBURG, PA 17050-8500
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,
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on the day following such date, operate as a certificate of release as defined ?
in IRC 6325(a). a 70
Tax Period Date of Last Da for Unpaid Bala nce
Kind of Tax Ending Identifying Number Assessment RefiLff of Assessment
(a) (b) (c) (d) (e) M
1040
1 12/31/2007 XXX-XX-6800 12/06/2010 01/05/2021 9322.41
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 9322.41
This notice was prepared and signed at DETROIT, MI , on this,
the 09th day of January 2012
Signature Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
(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)
Part 1 - Kept By Recording Office Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X