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11883
Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
IRev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording i0ffice
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 888698612
As provided by section 6321, 6322, and 6323 of the Internal Revenue ~"z " S""Z~' ~ 1~~~---
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
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additional penalties, interest, and costs that may accrue. C rri
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Name of Taxpayer BRIAN H & LORI J CAREY fV ~
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>ry s ~~-t
Residence 3 9 0 BENYOU LN Z
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NEW CUMBERLND, PA 17070-3074 ~ N~
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, f.
unless notice of the lien is refiled by the date given in column (e), this notice shall, fir, sZj . L"~ 'T'
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). ,~7~'~y~-
Tax Period Date of Last Dayy for Unpaid Bal nce
Kind of Tax Ending Identifying Number Assessment Refiling of Assess nt
(a) (b) (c) (d) (e) (f)
1040 12/31/2010 XXX-XX-7069 07/23/2012 08/22/2022 1 05.15
1040 12/31/2011 XXX-XX-7069 07/23/2012 08/22/2022 1689.42
Place of Filing
Prothonotary
Cumberland County Total $ 314.57
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 17th day of August 2012
Signature REVENUE OFFICER 22 - 0~ -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 T x lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 -Kept By Recording Office Form 668(Y)(c) (Rev. 2-20041
CAT. NO 60025X