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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) 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 863625212 / r
As provided by section 6321;h 6322, and 6323 of the Internal Revenue / °?
Code, we are giving a notice at taxe (including interest and penalties)
have been assessed against the follows g-named taxpayer. We have made
a demand for payment of this llity but it remains unpaid. Therefore,
there is a lien in favor of the united tates on all property and rights to
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property belonging to this taxpayer f r the amount of these taxes, and rn
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additional penalties, interest, and cos s that may accrue. xM z,.
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Name of Taxpayer BRIAN H CAREY c-
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Residence 390 BENYOU LN C=
NEW CUMBERLND, '; PA 17070-3074 .c-
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PORTANT RELEASE INFORMATI
i N: For each assessment listed below,
ess notice of the lien is refilled by the d
[ to given in column (e), this notice shall, ? -,7
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the day following such date, operate,
RC 6325
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i as a certificate of release as defined
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Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifys g Number Assessment Refilling of Assessment
(a) (b) c) (d) (e) (f)
1040 12/31/2009 XXX- X-7069 02/07/2011 03/09/2021 1236.02
Place of Filing
Prothonotary)
Cumberland County
Carlisle, PAj 17013
Total 1 $ 1236.02
This notice was prepared and signed at _ DETROIT, MI
, on this,
the 25th day of April 2012
Signature Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(NOTE: Certificate of officer authorized bylaw to take acknowledgment is not essential to the validity of Notice or i-eaerai i ax uen
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Pan i - Kept By Recording Office CAT. NO 60025X