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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(Rev. February 2004) Notice of Federal Tau Lien
Area: Serial Number For Option Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913 -6050 958749213 _
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, r
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 7
additional penalties, interest, and costs that may accrue. z M rn rn '
Name of Taxpayer FREDERICK M ESHLEMAN - ca mac?
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C7 �
Residence
1590 MENDENHALL DR D C -, C:)
MECHANICSBURG, PA 17050 -8353
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, C -r
on the day following such date, operate as a certificate of release as defined o;2
in IRC 6325(a).
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX -XX -2563 12/12/2011 01/11/2022 55146.11
Place of Filing
Prothonotary
Cumberland County Total $ 55146.11
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 04th day of September 2013
Signature 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)
AT Form 668( (Rev. 2-2004)
Part f - Kept By Recording Office CAT NO 60025X