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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 963281013 15
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,
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.
Name of Taxpayer DAVID G & JENNIFER R PIATT TM CJ
Residence 104 RUSTIC DRS
SHIPPENSBURG, PA 17257 -8750 � -�---
IMPORTANT RELEASE INFORMATION: For each assessment listed below, -t�
a / �S� 4.
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). r7� � L6 3
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 12/31/2012 XXX -XX -6726 06/03/2013 07/03/2023 10185.53
Place of Filing
Prothonotary
Cumberland County Total $ 10185.53
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 26th day of September 2013
Signature ��-� Title
� \Q_-_a� 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) Form 668(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X