HomeMy WebLinkAbout12-6112Form 668 (Y)(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 895031912
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notke that taxes (including interest and penakies)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remahu unpaid. Therefore,
there is a Ikn in favor of the United States on all property and rights to
property bebnging to this taxpayer for the amount of these taxes, and
addkional penakks, interest, and costs that may accrue.
ame
Residence 1513 CONII~lERCE AVE
CARLISLE, PA 17015-0000
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IMPORTAIIIT 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). ~~ ~ ~ ~~~~
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ealing Idernifying Number Assessment Refiling of Assessment
(a) [b) (c) (d) (e) [f)
2290 07/01/2010 36-4518084 07/25/2011 08/24/2021 1346.05
2290 07/01/2011 36-4518084 07/23/2012 08/22/2022 307.90
940 12/31/2008 36-4518084 08/08/2011 09/07/2021 5777.63
940 12/31/2011 36-4518084 06/11/2012 07/11/2022 87.77
941 06/30/2011 36-4518084 09/05/2011 10/05/2021 1154.91
941 09/30/2011 36-4518084 01/02/2012 02/01/2022 1022.25
941 12/31/2011 36-4518084 04/09/2012 05/09/2022 18233.07
941 03/31/2012 36-4518084 06/04/2012 07/04/2022 7956.89
Place of Filing
This notice was prepared and signed at DETROIT, MI
the 20th day of September 2012
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 35886.47
on this,
Signature /'-; ~~ ~~ REVENUE OFFICER 22 - 06 -1418
for JAKOB PEDERSEN (717) 777-9621
For Optional Use by Recording Office
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(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 Wnce Form 668(Y)(c) (Rev. 2-20041
CAT. NO 60025X