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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) 913 -6050 963746013
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 HI C0
F
additional penalties, interest, and costs that may accrue. i
Name of Taxpayer SCOTT B LEVAN N ca
C) 3
Residence t� ''
130 N 32ND ST - --
CAMP HILL, PA_17011 -2919
CIO
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, of •J - L
on the day following such date, operate as a certificate of release as defined /
in IRC 63251x).
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 -1481 10/22/2012 11/21/2022 15094.08
1040 12/31/2010 XXX -XX -1481 12/12/2011 01/11/2022 50326.63
1040 12/31/2011 XXX -XX -1481 06/18/2012 07/18/2022 17062.21
1040 12/31/2012 XXX -XX -1481 05/06/2013 06/05/2023 27847.24
Place of Filing
Prothonotary
Cumberland County Total $ 1103 3 0.16
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 30th day of September 2013
Signature Title
REVENUE OFFICER 22 -06 -1408
for MIGNA RODRIGUEZ (717) 777 -9622
(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)
Part 1 - Kept By Recording Office Form 668( CAT (Rev. 2 - 2004)
CAT. NO 60025X