HomeMy WebLinkAbout12-5116Form 668 M(c)
(Rev. February 2004)
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 886990312
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.
Name of Taxpayer
Residence 1712 LETCHWORTH RD
CAMP HILL, PA 17011-7528
rY] C
M
may.. !?"? ?F Y -.
-E 2: --? -
c ^? rD
_
C"::
-4
Loiun ORTANT RELEASE INFORMATION: For each assessment listed below,
ss notice of the lien is refiled by the date given in column (e), this notice shall,
he day following such date, operate as a certificate of release as defined
C 6325(x). l r lf,
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending ldentifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2010 XXX-XX-9494 05/30/2011 06/29/2021 42468.53
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
For Optional Use
Office
Total 1$ 42468.53
This notice was prepared and signed at DETROIT, MI
the 09th day of August 2012
, on this,
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 I - Kept By Recording Office CAT. 668( (Rev. 2 2004)
CAT. NO 60025X