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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) 913 -6050 946531313 3
provided by section 6321, 6322, and 6323 of the Internal Revenue `3 3
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 to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. C=
Name of Taxpayer TIMOTHY D & CARRIE M ARNOLD =M C rM -_
t
C/) 7-0
N 6r"`
Residence 6995 WERTZVILLE RD <CD
MECHANICSBURG, PA 17050 - 15410.
r _ ! T
Fin ORTANT RELEASE INFORMATION For each assessment listed below, r,2/ �(,
s notice of the lien is refiled by the date given in column (e), this notice shall,
he day following such date, operate as a certificate of release as defined��� ��
C 6325(a).
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 -6176 04/15/2011 05/15/2021
1040 12/31/2010 XXX -XX -6176 05/09/2011 06/08/2021
1040 12/31/2010 XXX -XX -6176 04/29/2013 05/29/2023 9597.75
Place of Filing
Prothonotary
Cumberland County Total $ 9597.75
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 25th day of June 2013
Signature � �{ Title
REVENUE OFFICER 22 -06 -1418
for JAKOB PEDERSEN (717) 777 -9621
(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