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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
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829 -7650 955677213 13- 7 r ��
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 r°3 `
rn CO � Z -n
property belonging to this taxpayer for the amount of these taxes, and :ZM rr1r=
additional penalties, interest, and costs that may accrue. c tv M6
Name of Taxpayer GARY R & TAMEY BIRD t"; Oc-�
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CJ
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Residence 44 LENWOOD .PARK � ;
SHIPPENSBURG, PA 17257 -8707 C�
IMPO :6325(a). NT RELEASE INFORMATION: For each assessment listed below,
unless e of the lien is refiled by the date given in column (e), this notice shall, ct
on the following such date, operate as a certificate of release as defined c�I• S v
in IRC
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 12/31/2004 XXX -XX -6246 06/06/2005 07/06/2015 6780.61
Place of Filing
Prothonotary
Cumberland County Total $ 6780.61
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 15th day of August 2013
Signature � ACS W &I 11 -00 -0000
for DEANN BENDER (800) 829 -7650
(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