HomeMy WebLinkAbout12-1848Form 668 (Y)(c)
(Rev. February 2004)
4bu4
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 855305012
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made d>
a demand for payment of this liability, but it remains unpaid. Therefore, W
there Is a lien in favor of the United States on all property and rights to qtr 7?i
property belonging to this taxpayer for the amount of these taxes, and = M -c.
additional penalties, Interest, and costs that may accrue. cn tv°
Name of Taxpayer MARY E HOOPER
CRIMSON FROG COFFEEHOUSE mac- ?.....
Residence
1104 CARLISLE ROAD
rv
CAMP HILL, PA 17011-6203
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).
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Kind of Tax Tax Period
Ending
identifying Number Date of
Assessment Last Dayy for
Refiling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/2008 20-1551268 03/21/2011 04/20/2021 405.77
941 09/30/2010 20-1551268 03/28/2011 04/27/2021 2719.34
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 3125.11
This notice was prepared and signed at
the 15th day of March
DETROIT, MI
2012
, on this,
Signature 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 Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X
Department of the Treasury - Internal Revenue Service