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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #5
Lien Unit Phone: (800) 913 -6050 961921713 13
As provided by section 6321, 6322, and 6323 of the Internal Revenue J
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 z � ,�' ; s v�
additional penalties, interest, and costs that may accrue.
te r - 70
Name of Taxpayer RONALD VAN ART --j Sc
CD
Residence PO BOX 147 c
SHIPPENSBURG, PA 17257 Z
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, �l S� , , 7'
on the day following such date, operate as a certificate of release as defined /
in IRC 6325(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 12/31/2007 XXX -XX -3640 10/12/2009 11/11/2019 1931.18
1040 12/31/2010 XXX -XX -3640 06/17/2013 07/17/2023 60428.12
1040 12/31/2011 XXX -XX -3640 07/30/2012 08/29/2022 749.48
Place of Filing
Prothonotary
Cumberland County Total $ 63108.78
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 18th day of September 2013
Signature ��� Title
\� 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