HomeMy WebLinkAbout12-2589Form 668 (Y)(c)
(Rev. February 2004)
4804
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 862780212
As provided by section 6321, 6322, and 6323 of the Internal Revenue j
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made tr
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: *a = - ,
property belonging to this taxpayer for the amount of these taxes, and r n'V ;
additional penalties, interest, and costs that may accrue. ?,
in
Name of Taxpayer JOHN W DAVIDSON
...s
JOHNS REFRIGERATION r'" a`
A C-1
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Residence 6 DYKEMAN RD ':' •• ?
SHIPPENSBURG, PA 17257-8701 i
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, /)7? ,o`
on the day following such date, operate as a certificate of release as defined /
in IRC 6325(a). /?Y7'f y3z
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)
941 06/30/2010 25-1700778 09/20/2010 10/20/2020 4042.57
941 09/30/2010 25-1700778 12/20/2010 01/19/2021 3168.99
941 12/31/2010 25-1700778 04/11/2011 05/11/2021 2589.98
941 03/31/2011 25-1700778 07/04/2011 08/03/2021 2049.86
941 06/30/2011 25-1700778 10/03/2011 11/02/2021 683.16
Place of Filing
Prothonotary
Cumberland County Total $ 12534.56
Carlisle, PA 17013
This notice was prepared and signed at
the 20th day of April
DETROIT, MI
2012
, on this,
Signature Title
?\C-4s? REVENUE OFFICER 22-06-2620
for JACOB KAISER (304) 263-7625
(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( N (Rev. 2 2004)
CAT. NO 60025X