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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 O ffice
SMALL BUSINESS /SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913 -6050 959433013
As provided by section 6321, 6322, and 6323 of the Internal Revenue /3 j y/ "7 - 77-
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 - 4,,> --s
property belonging to this taxpayer for the amount of these taxes, and XM r` � r
additional penalties, interest, and costs that may accrue.
Name of Taxpayer JOHN F MIRA
Residence 2 RUSH DR APT 303 5 >
CARLISLE, PA 17013 -2262'
C
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, v
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). l� "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) M
1040 12/31/2007 XXX -XX -2457 05/06/2013 06/05/2023 25656.52
1040 12/31/2008 XXX -XX -2457 02/15/2010 03/16/2020 5328.06
1040 12/31/2009 XXX -XX -2457 04/18/2011 05/18/2021 18037.96
Place of Filing
Prothonotary
Cumberland County Total $ 49022.54
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 06th day of September 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) Form 668(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X