HomeMy WebLinkAbout12-7416Form 668 (Y)(c)
(Rev. February 2004)
11883
Department of the Treasury -Internal Revenue Service
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 908506812
As provided by section 6321, 6322, and 6323 of the Internal Revenue /`~ " 75%4, ~ ~L-
Code, we are ghrh>tg a notice that taxes (including interest and penahks)
have been assessed against the fdlowing-named taxpayer. We have made
a demand for payment of thLs liabilh7r, but it remains unpaid. Therefore,
there is a lien ht favor of the lJnited States on all property and rights to
Property bonging to thLs taxpayer for the amour of these taxes, and ; ; ,~, '.~'
additional penalties, interest, and costs that may accrue. '~
Name of Taxpayer CHARLES R & KAREN S DAVIS ~ ~ ~
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Residence
19 TUSCANY CT -
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CAMP HILL, PA 17011-1029 sA
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, -
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unless notice of the lien is refiled by the date given in column (e-, this notice shall, -
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on the day following such date, operate as a certificate of release as defined ~/•~~
ad~ C, 7"
in IRC 6325(a). ~
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Tax Period Date of Last
D
r for U~aid Balance
Kind of Tax Ending Identifying Number Assessment R
~ of Assessment
a) b c) d e
1040 12/31/2010 XXX-XX-1023 12/05/2011 01/04/2022 4197.27
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total I $ 419 7.2 7
This notice was prepared and signed at
DETROIT, MI
the 28th da of November 2012
_____ Y ,
on this,
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)(t) IRev. 2-2004)
Part 1 -Kept By Recording ORke CAT. NO 60025X