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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 #1
Lien Unit Phone: (800) 913 -6050 952382113 >>��
As provided by section 6321, 6322, and 6323 of the Internal Revenue 13 _ 74 - (7)
Code, we are giving a notice that taxes (including interest and penalties) 4
have been assessed against the following -named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, z M C= 7 r -
there is a lien in favor of the United States on all property and rights to n i G ,'' -
property belonging to this taxpayer for the amount of these taxes, and --< y C '
additional penalties, interest, and costs that may accrue. CD =„ =T,
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Name of Taxpayer JEFFERY A & SHARON A MAY CD
C11
Residence 192 TEXACO RD
MECHANICSBURG, PA 17050 -2624
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, o ? /• S� �ot � /
on the day following such date, operate as a certificate of release as defined
in IRC 6 225(a). f1 oZ / C'L/4( o Lf
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2010 XXX -XX -5700 05/17/2012 06/16/2022 384.84
1040 12/31/2011 XXX -XX -5700 04/15/2012 05/15/2022 802.72
1040 12/31/2012 XXX -XX -5700 04/15/2013 05/15/2023 4277.68
Place of Filing
Prothonotary
Cumberland County Total $ 5465.24
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 29th day of July 2013
Signature Title
ACS SBSE 21 -00 -0008
for P.A. BELTON (800) 829 -3903
(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