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Department of the Treasury -Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Nonce 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 917593713
As provided by section 632 t, 6322, and 6323 of the Internal Revenue ~ 3 S/ ~3 ~ ~~
Code, we are giving a notice that taxes (including interest and penalties) ~
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have been assessed against the following-named taxpayer. We have made _
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a demand for payment of this liability, but it remains unpaid. Therefore, ~o ~ ~' .~ -,,
there is a lien in favor of the united States on all property and rights to ~~, ~ '...~t~_
property belonging to this taxpayer for the amount of these taxes, and ~ ~ '"' :}
additional penalties, interest, and costs that may accrue. u'
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Name of Taxpayer ANDREAS R JANKOWSKY ~-~
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Residence 1186 CREEK RD . _
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MECHANICSBURG, PA 17055-9762 _,
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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 (e1, this notice shall,
on the day following such date, operate as a certificate of release as defined ~, ~ ~~ ~ -~
in IRC 6325(a). ~ j~-~ ,~,~ 5S s~. ~ e
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 12/31/2006 XXX-XX-1207 01/12/2009 02/11/2019 1184.35
1040 12/31/2007 XXX-XX-1207 10/20/2008 11/19/2018 2716.90
1040 12/31/2010 XXX-XX-1207 11/07/2011 12/07/2021 445.61
1040 12/31/2011 XXX-XX-1207 05/28/2012 06/27/2022 9304.21
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total ~$ 13651.07
This notice was prepared and signed at
the 22nd day of January
DETROIT, MI
2013
on this,
Signature /" '~ Title
~ \C-~rG 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)(c) (Rev. 2-2004)
Part t -Kept BY Recording Office CAT. NO 60025X