HomeMy WebLinkAbout12-5114Form 668 (Y)(c)
(Rev. February 2004)
1
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650 886978712
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.
ame of Taxpayer
Residence 50 DIANE CIR
CAMP HILL, PA 17011-1801
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
I Use by Recording Office
r 11
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12" a -2
Kind of Tax
(a) Tax Period
Ending
(b)
Identifying Number
(c) Date of
Assessment
(d) Last Dayy for
Refiling
(e) Unpaid Balance
of Assessment
(f)
1040 12/31/2005 XXX-XX-6813 09/19/2011 10/19/2021 332.83
1040 12/31/2006 XXX-XX-6813 10/10/2011 11/09/2021 160.53
1040 12/31/2007 XXX-XX-6813 12/20/2010 01/19/2021 36723.51
1040 12/31/2008 XXX-XX-6813 04/11/2011 05/11/2021 3222.22
1040 12/31/2009 XXX-XX-6813 09/26/2011 10/26/2021 458.15
1040 12/31/2010 XXX-XX-6813 09/26/2011 10/26/2021 157.04
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $
41054.28
This notice was prepared and signed at DETROIT, MI
the 09th day of August 2012
, on this,
Signature Title
\C--?-? 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