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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 20041 Notice of Federal Tax Lien
Area:
SMALL Serial Number For Optional Use by Recording Office
BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: {800) 829-3903 910612712
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ded 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. ~ ''~' -
Name of Taxpayer ADAM A LENTZ -'-~"~ '`' -
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Residence 3500 LISBURN RD r
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MECHANICSBURG, PA 17055-6712 ~```'' --n --~-
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IMPORTANT RELEASE INFORMATION: For each assessment listed below , v -
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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
in IRC 6325fa).
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Kind of Tax Tax Period
Ending
Identifying Number Date of
Assessment Last Dayy for
Refiling Unpaid Balance
of Assessment
(a) (b) (c) (d) (e) (~
1040 12/31/2004 XXX-XX-7181 02/19/2007 03/21/2017 7136
76
1040 12/31/2007 XXX-XX-7181 02/11/2008 03/13/2018 .
1379.28
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 8516.04
This notice was prepared and signed at DETROIT, MI
the 07th day of December 2012
on this,
Signature ~ ~~ Title
\ \ ACS SBSE 22-00-0001
for P.A. BECTON (800) 829-3903
.•~~•~. ~G~ ~~~~~a~C ui orricer aurnonzeo oy iaw 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 Office Form 668(Y)(c) (Rev. 2-20041
CAT. NO 60025X