HomeMy WebLinkAbout12-4515Form 668 (Y)(c)
(Rev. February 2004)
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 880966212
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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 CID
a demand for payment of this liability, but it remains unpaid. Therefore, -03 ; -+
there is a lien in favor of the United States on all property and rights to rrjW L
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property belonging to this taxpayer for the amount of these taxes, and 71
additional penalties, interest, and costs that may accrue. o S'';'
Name of Taxpayer MYRON GOLDEN -ti
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Residence 6 LYNCHBURG CT
MECHANICSBURG, PA 17050-1748
IMPORTANT RELEASE INFORMATION: For each assessment listed below, .i
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
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IRC 6 225(
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Tax Period Date of Last Day for Unpaid Bal ance
Kind of Tax Ending Identifying Number Assessment Refiling of Assess nt
(a) (b) (c) (d) (e) (f)
1040 12/31/2009 XXX-XX-6028 01/10/2011 02/09/2021
1040 12/31/2009 XXX-XX-6028 06/11/2012 07/11/2022 842 35.00
Place of Filing
Prothonotary
Cumberland County Total $ 8421- 5.00
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 12th day of July 2012
Signature Title
REVENUE OFFICER 22-0 6-1418
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) Form 668(Y)(c) (Rev. 2-2004)
Part 1 -Kept By Recording Office CAT. NO r0025X