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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 975344513
As provided by section 6321, 6322, and 6323 of the Internal Revenue `:
Code, we are giving a notice that taxes (including interest and penalties) - eat - --#
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 tV r
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property belonging to this taxpayer for the amount of these taxes, ands -' c)
additional penalties, interest, and costs that may accrue. ra
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Name of Taxpayer TIMOTHY J ORNDORF ry T{t
Residence 9974 MOLLY PITCHER HWY
SHIPPENSBURG, PA 17257 -8503
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 Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/2011 25- 1403535 10/21/2013 11/20/2023 2356.94
941 06/30/2011 25- 1403535 10/14/2013 11/13/2023 3500.78
941 09/30/2011 25- 1403535 10/14/2013 11/13/2023 4136.13
941 12/31/2011 25- 1403535 10/14/2013 11/13/2023 4172.60
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Place of Filing
Prothonotary
Cumberland County Total $ 14166.45
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 23rd day of December 2013
Signature Title
\ \C--� REVENUE OFFICER 22 -06 -2620
for JACOB KAISER (304) 263 -7625
(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