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11883
Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c) Nice Of Federal Tax Lien
IRev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 915153213
As provided by secdon 6321, 6322, and 6323 of the Intemal Revenue
Code, we are 8ivht~ a notice that taxes (includh~= interest and penaN3es)
have been ~ a~nst the fofiowin~-named taxpayer. We have made ~ ,~
~
a demand for ~ this liab~ty, but it remsiss unpaid. Therefore, ~ `~ '
'
there is a lien in favor of the united States on all property and rights to ,'~~ ~ ~.' -z i
Property b~onph~ to this taxpayer for the amount of these taxes, and ~ ~ ~ ~
additional penah~es, interest, and costs that may accrue. ~ ~ ~
~ ~
Name of Taxpayer JIM MARTIN ,~o ~~
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Xca ~ ~~s
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Residence 213 GULL CT ~ r~ r ~
MECHANICSBURG, PA 17050-2057 -~ -c" ~`
IMP4RTA1~fT RELEASE Ii~tF~RMATION: For each assessment {fisted below,
unless notice of the lien is refi{ed by the date given in column le), 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 Lastfor W~aid Balance
Kind of Tax Ending Identi(yin8 Number Asses:,nent g of Assessment
a b c) d e
1040 12/31/2009 XXX-XX-2132 05/23/2011 06/22/2021 3210.43
1040 12/31/2010 XXX-XX-2132 05/30/2011 06/29/2021 2572.35
1040 12/31/2011 XXX-XX-2132 10/01/2012 10/31/2022 1496.07
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 7278.85
This notice was prepared and signed at
the 07th day of January
DETROIT, MI
2013
_ , on this,
tai . ~o po Pt.FF
~T
e#assya~l
Signature ~C~-~ ACS SBSE 22-00-0008
for G.J. `CARTER`-LOUIS (800) 829-3903
(ROTE: 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 - Kq-t sY Recording OlBce Form 668(lf)(c) (Rev. 2-2004)
CAT. NO 60025X