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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829 -3903 934421413
As provided 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, 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 ZZ; � -,ri
additional penalties, interest, and costs that may accrue. :=M M r:
Name of Taxpayer DAVID C REGAL
CA 6 ca
--n
3 S WEST AVER
i l71
CAMP HILL, PA 17011 -6544
IMPORTANT RELEASE INFORMATION For each assessment listed :belo
unless notice of the lien is refiled by the date given in column (e), this noticl, - _� on the day following such date, operate as a certificate of release as dd
in IRC 6325(a). 7O�
Tax Period Date of Last Day 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 -4242 08/13/2012 09/12/2022 66464.90
1040 12/31/2009 XXX -XX -4242 08/13/2012 09/12/2022 61586.14
Place of Filing
Prothonotary
Cumberland County Total $ 128051.04
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI , on this,
the 18th day of April 2013
Signature 1 -' Title 22 -00 -0001
` ` ACS SBSE
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) Form 668(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X