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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 941793413
/3 - 3�27/
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 - a :r
property belonging to this taxpayer for the amount of these taxes, and rtl c r=
::,:)
additional penalties, interest, and costs that may accrue. r-° f ,
CD
Name of Taxpayer DONALD B MICHAELS , -- i
c
Residence = °:'�
52 BEETEM HOLLOW RD 16W
NEWVILLE, PA 17241 -9541
I :tShe TANT RELEASE INFORMATION For each assessment listed below,
uotice of the lien is refilled by the date given in column (e), this notice shall,
oday following such d ate, operate as a certificate of release as defined i325(a).
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 12/31/2007 XXX -XX -1397 10/24/2011 11/23/2021 3844.33
1040 12/31/2008 XXX -XX -1397 10/24/2011 11/23/2021 10723.25
Place of Filing
Prothonotary
Cumberland County Total $ 14567.58
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 29th day of May 2013
Signature � 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(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X