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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 #2
Lien Unit Phone: (800) 829 -3903 963280913
As provided by section 6321, 6322, and 6323 of the Internal Revenue 13 _ tea
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 �? '
< rA A•A t
additional penalties, interest, and costs that may accrue. _.
Name of Taxpayer DAVID G PIATTrn� cZ> 3`
cn r— -= ,
-< tv {=
Residence
104 RUSTIC DR
SHIPPENSBURG PA 17257 -8750 r ' 2 -
c� co
IMPORTANT RELEASE INFORMATION: For each assessment listed below, r '
unless notice .of the lien is refiled by the date given in column (e), this notice shall, � _
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). MP a 7
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 12/31/2009 XXX -XX -6726 06/20/2011 07/20/2021 2891.67
1040 12/31/2010 XXX -XX -6726 05/30/2011 06/29/2021 4725.24
1040 12/31/2011 XXX -XX -6726 11/19/2012 12/19/2022 24713.81
Place of Filing
Prothonotary
Cumberland County Total $ 32330.72
Carlisle, PA 17013
This notice was prepared and sighed at DETROIT, MI , on this,
the 26th day of September 2013
Signature Title
\ C-- ACS SBSE 22 -00 -0001
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)
Pan 1 - Kept By Recording Office Form 668( CAT (Rev. 025X )
CAT. NO 60025X