HomeMy WebLinkAbout12-6341Form 668 (Y)(c)
(Rev. February 2004)
11883
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 896930712
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.
ame of Taxpayer SHAUN
Residence 320 PINE GROVE RD
GARDNERS, PA 17324-8972
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, _
unless notice of the lien is refiled by the date given in column (e), this notice shall, oZ ?G1 ` ?
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). At"Or .2 IV-/,f 4I/
Office
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Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refing of Assessment
(a) (b) (c) (d) (e)
1040 12/31/2007 XXX-XX-7519 11/29/2010 12/29/2020
1040 12/31/2007 XXX-XX-7519 02/20/2012 03/22/2022 205410.83
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
For
Use
Total 1$ 205410.83
This notice was prepared and signed at
the 01st day of October
DETROIT, MI
2012
, on this,
Signature 11-\ C?? REVENUE OFFICER 22-06-1842
for DAVID M SHROYER (717) 757-2320
(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