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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
A Serial Number For Optional Use by Recording ffice
rea:
SMALL BUSINESS/SELF EMPLOYED AREA #2 !
Lien Unit Phone: (800) 913-6050 877519812 j
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 c =i
property belonging to this taxpayer for the amount of these taxes, and _ :x ? , -
z
additional penalties, interest, and costs that may accrue. k-
Name of Taxpayer GREG L & KAREN D ANDERSON
Residence 4103 CLUB HOUSE DR ZC- 3
MECHANICSBURG, PA 17055-7622 Dz errs
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refired 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). 57)?
Tax Period Date of Last Day for Unpaid Bala nce
Kind of Tax Ending Identifying Number Assessment Refiring of Assessm ent
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX-XX-8249 11/23/2009 12/23/2019 122 0.96
1040 12/31/2009 XXX-XX-8249 11/29/2010 12/29/2020 64 2.67
1040 12/31/2010 XXX-XX-8249 11/28/2011 12/28/2021 104 8.26
Place of Filing
Prothonotary
Cumberland County Total $ 2918 L.89
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI n this,
the 25th day of June 2012
Signature ACS SBSE 22-00 -0008
for G.J. CARTER-LOUIS (800) 829-3903
(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. -2004)
Part I - Kept By Recording Office CAT. NO 6 025X
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