HomeMy WebLinkAbout12-5213Form 668 (Y)(c)
(Rev. February 2004)
118
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 887787812
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As provided by section 6321, 6322, and 6323 o
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, r
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 rnw .
additional penalties, interest, and costs that may accrue.
Name of Taxpayer WALTER W BRAITHWAITE ?'M +-
> c- r - ..,
Residence 62 CHELSEA LANE %.:
CARLISE, PA 17015 .,' M
47-
IMPORTANT LEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall, j
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2010 XXX-XX-9880 06/27/2011 07/27/2021
1040 12/31/2010 XXX-XX-9880 05/14/2012 06/13/2022 1298.11
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$ 1298.11
This notice was prepared and signed at DETROIT, MI
the 14th day of August 2012
, on this,
Signature Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
(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 60025X