HomeMy WebLinkAbout12-2503Form 668 (Y)(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 913-6050 861850312
As provided by section 6321, 6322, and 6323 of the internal Revenue
Code, we are giving a notice that taxes (including interest and penakies)
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.
Name of Taxpayer JORGE DIAZ
Residence 45 CIRCLE PL
CAMP HILL, PA 17011-2928
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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, a/- SID f,C,il T
on the day following such date, operate as a certificate of release as defined 1
in IRC 6325(a). "', oZ 7y?lo !?
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) d (e) (f)
1040 12/31/2010 XXX-XX-7955 03/07/2011 04/06/2021
1040 12/31/2010 XXX-XX-7955 10/03/2011 11/02/2021 65278.57
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
For Optional Use by Recording Office
Total 1$ 65278.57
This notice was prepared and signed at
the 17th day of April
DETROIT, MI
2012
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Signature REVENUE OFFICER 23-08-1818
for MR. C.D. BAILEY (954) 423-7374
(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 lI - Kept By Recording Office CAT. NO 60025X