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11883
Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 890574212 r
As provided by section 6 21, 6322, and 6323 of the Internal Revenue J°~ -,js~-SJ
Code, we are giving a noti a that taxes (including interest and penalties)
have been assessed agains the following-named taxpayer. We have made ~
a demand for payment of his liability, but it remains unpaid. Therefore, ~ ~
there is a lien in favor of he United States on all property and rights to ~ ro
property belonging to this taxpayer for the amount of these taxes, and ~r
additional penalties, interest, and costs that may accrue.
Name of Taxpayer DAVID RIFE ~ a'~"-
ZG7 ~
Residence 7 E GR~EN ST ~ -s
SHIREM~,NSTOWN, PA 17011-6551
IMPORTANT RELEASE 1 FORMATION: For each assessment listed below,
unless notice of the lien is re filed by the date given in column (e?, this notice shall, ~ S v 1~( ~
on the day following such date, operate as a certificate of release as defined ~ L~•.
in IRC 6325(a). a~('.~J" )r'
Tax Period) Date of Last Dayy for lJnpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/20]~l XXX-XX-1764 05/21/2012 06/20/2022 4565.39
Place of Filing
Prothonotary
Cumberland County Total $ 4565.39
Carlisle, PA 17013
This notice was prepared and signed at _ DETROIT, MI , on this,
the 28th day of August 2012
Signature ACS SBSE 22-00-0001
for P.A. BECTON (800) 829-3903
(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