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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) 913 -6050 938012413 43 d 70f A
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,
there is a lien in favor of the United States on all property and rights fo =
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. �" °
Name of Taxpayer JEREMIAH J YOUNG C
Z C'j. _
I> co
Residence 8 MOUNT ROCK RD
NEWVILLE, PA 17241 -9414
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 �f �� �( L .
in IRC 6325(a). aOSD3
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2010 XXX -XX -7976 06/20/2011 07/20/2021 8396.92
Place of Filing
Prothonotary
Cumberland County Total $ 8396.92
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 07th day of May 2013
Signature Title
REVENUE OFFICER 22 -06 -2617
for J. MACDONALD (304) 263 -7625
(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( CAT (Rev. 025X )
Part 1 - Kept By Recording Office
CAT. NO 60025X