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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 969297313
As provided by section 6321, 6322, and 6323 of the Internal Revenue /3 '137 , C:� -I'L
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, r
there is a lien in favor of the United States on all property and rights to a: r� m
property belonging to this taxpayer for the amount of these taxes, and -0 ZZ, --
additional penalties, interest, and costs that may accrue. M co �—'
Name of Taxpayer ADAM A LENTZ
- N CD C
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Residence PO BOX 564 C-)
CAMP HILL, PA 17001 -0564 A i
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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, %
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Da yy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX -XX -7181 04/15/2009 05/15/2019
1040 12/31/2008 XXX -XX -7181 03/19/2012 04/18/2022
1040 12/31/2008 XXX -XX -7181 12/10/2012 01/09/2023 2612.84
Place of Filing
Prothonotary
Cumberland County Total $ 2612.84
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 15th day of November 2013
Signature Title
C--� 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. Rut. 71 -466, 1971 - 2 C.B. 409)
AT
Part 1 - Kept By Recording Office Form 668( C (Rev. 2 -
CAT. NO 60025X X