HomeMy WebLinkAbout12-3406Form 668 (Y)(c)
(Rev. February 2004)
1
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 869574412
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
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.
Vame of Taxpayer THADDEY L & DARLENE L CHAMBERLIN
Residence 103 LEWISBERRY RD
NEW CUMBERLND, PA 17070-2418
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 day following such date, operate as a certificate of release as defined
in IRC 6325(a).
For Optional Use by Recording Office
Tj U?
?9Jt ? 7_SS/Ii?
Kind of Tax
(a) Talc Period
Ending
(b)
Identifying Number
(c) Date of
Assessment
(d) Last Day for
Refiling
(e) Unpaid Balance
of Assessment
M
1040 12/31/2010 XXX-XX-5370 10/24/2011 11/23/2021 9296.63
Place of Filing
Prothonotary
Cumberland County Total $ 9296.63
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI
on this,
the 22nd day of May 2012
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 CAT. 668( (Rev. 2 20041
CAT. NO 60025X