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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(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 870152012
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 Unit
d St
t
ll
e
a
es on a
property and rights to
property belonging to this taxpayer for the amount of these taxes, and
'j
additional penalties, interest, and costs that may accrue. '' ,
Name of Taxpayer AVID P STAILEY ':
Residence 3 515 ROLO CT
MECHANICSBURG, PA 17055-5893
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 da
followin
such d
t
ifi
y
g
a
e, operate as a cert
cate of release as defined
in IRC 6325(a). ?7? `f to
Kind of Tax Tait Period
Ending
Identifying Number Date of
Assessment Last Dayy for
Refiling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2007 XXX-XX-7814 07/25/2011 08/24/2021 3831.57
1040 12/31/2008 XXX-XX-7814 07/25/2011 08/24/2021 4376.31
1040 12/31/2009 XXX-XX-7814 04/16/2012 05/16/2022 2745.52
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 10953.40
This notice was prepared and signed at
the 23rd day of May
DETROIT, MI
2012
, on this,
Signature Title
ACS W&I 11-00-0000
for DEBRA K. HURST (800) 829-7650
(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