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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 For Optional Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829 -3903 933840013
As provided by section 6321, 6322, and 6323 of the Internal Revenue 13
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, C—,
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 rn rn Xr. n
additional penalties, interest, and costs that may accrue.
Name of Taxpayer BRET E ROWZER -ems
Residence 789 FISHING CREEK RD
NEW CUMBERLND, PA 17070 -2749
IMPORTANT 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). v2G�
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX -XX -6296 12/26/2011 01/25/2022 20906.11
Place of Filing
Prothonotary
Cumberland County Total $ 20906.11
Carlisle, PA 17013
This notice was prepared and signed at DETROI MI , on this,
the 16th day of April 2013
Signature Title
ACS SBSE 22 -00 -0001
for P.A. BELTON (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)
Part t -Kept By Recording Office Form 668(Y)(c) (Rev. 2 - 2004)
CAT. NO 60025X