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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 976279213
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 '
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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 rfi
property belonging to this taxpayer for the amount of these taxes, and t .
additional penalties, interest, and costs that may accrue. > '� Cj
Name of Taxpayer STEVEN & VIRGINIA COOVERr -
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Residence 109 LOGAN LN
SHIPPENSBURG, PA 17257 -9266
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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, 0 1pt �• / -
on the day following such date, operate as a certificate of release as defined /
in IRC 6325(a). JF 3b0 JJ
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2009 XXX -XX -6056 09/03/2012 10/03/2022 19050.95
1040 12/31/2011 XXX -XX -6056 11/19/2012 12/19/2022 49779.69
1040 12/31/2012 XXX -XX -6056 06/03/2013 07/03/2023 53150.86
Place of Filing
Prothonotary
Cumberland County Total $ 121981.50
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 31st day of December 2013
Signature Title
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