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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 947382613
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 c `-
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 MCD C— " <
rT? i
property belonging to this taxpayer for the amount of these taxes, and additional penalties, penalties, interest, and costs that may accrue.
Name of Taxpayer EMORY G & CATHERINE M JOHNSON
7 >
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Residence 555 WHISKEY RUN RD
NEWVILLE, PA 17241- 8625
IMPORTANT RELEASE INFORMATION For each assessment listed below,
unless notice of the lien is refired 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). �a2�j,3Dlo�
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiring of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2012 XXX -XX -3023 06/03/2013 07/03/2023 10146.88
Place of Filing
Prothonotary
Cumberland County Total $ 10146.88
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 28th 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)
Part 1 - Kept By Recording Office Form 66B( CAT NO 025X )
CAT. NO 60025X