HomeMy WebLinkAbout12-1609Form 668 (Y)(c)
(Rev. February 2004)
36
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 853221612
As provided by section 6321, 6322, and 6323 of the Internal Revenue 4o9 - APM
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 o
--4
property belonging to this taxpayer for the amount of these taxes
and .oZ
mW "r'
,
additional penalties, interest, and costs that may accrue. rn x,.
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Name of Taxpayer RICKY L MOTTER ??A w C5
Residence
39 MOTTER DR =C)
5,CZ o
SHIPPENSBURG, PA 17257-9734
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 da
f
ll
i
h d
T-
y
o
ow
ng suc
ate, operate as a certificate of release as defined
in IRC 6325(a). nL
Fes[ 2
Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Day for
Refiling Unpaid Balance
of Assessment
(a) (b) c) (d) (e) (17
1040 12/31/2010 XXX-XX-6527 06/13/2011 07/13/2021 9497.67
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 9497.67
This notice was prepared and signed at
the 05th day of March
DETROIT, MI
2012
, on this,
Signature
?er Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(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 CAT. 668( (Rev. 2 2004)
CAT. NO 60025X