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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 949766013
As provided by section 6321, 6322, and 6323 of the Internal Revenue / 3 -3/� 7'L
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 C: = ''
additional penalties, interest, and costs that may accrue. M rA c � -
a er PETER A DEVITIS
P Y cn r
Name of Tax ry i-
►�-
Residence 776 LINCOLN WAY E CZ)
CHAMBERSBURG, PA 17201 -2707 = �'
FRC NT RELEASE INFORMATION For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
following such date, operate as a certificate of release as defined
5(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 12/31/2012 XXX -XX -7582 05/27/2013 06/26/2023 7483.65
Place of Filing
Prothonotary
Cumberland County Total $ 7483.65
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 16th day of July 2013
Signature Ti /- -�� EENUE OFFICER 22 -06 -2620
for JACOB �KAISE�R (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