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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 897517312
As provided by section 6321, 6322, and 6323 of the Internal Revue
Code, we are jiving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for 6nyment of this liability, but it remains unpaid. Therefore,
there its alien favor of the united States on ag property and rights to
property bg to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Vame of Taxaavdr NORRIS CNTT,n CARP: (r)V-QTTT.'TAWMC TTTfl
a Corporation
Residence PO BOX P
NEW CUMBERLND, PA 17070-0227
For Optional Use
Ja - 61-10 -7 /:::?71-
IMPOR1ANT 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).
Kind of Tax # En?g ldendb4ng Number Assessment ReflibliQ
(a b c (d e
941 06/30/2012 25-1864773 09/17/2012 10/17/2022
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
3380.79
Total 1$ 3380.79
This notice was prepared and signed at
the 03rd day of October
DETROIT, MI
2012
, on this,
Signature Title
?C{ REVENUE OFFICER 22-06-1418
for JAKOB PEDIERS EN (717) 777-J621
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$ M? C")
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a., ?Y POW w Lane acRnuwieaymemt is not essentiai to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part I - Kept By Record Office Form 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X