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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829 -7650 976280313
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 - �
additional penalties, interest, and costs that may accrue. - -
Name of Taxpayer AMBER E & JACKLISON R RUIZ RIVERA 7 _
Residence 351 N HANOVER ST `-' X_
CARLISLE, PA 17013 - 1928.
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 for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f7
1040 12/31/2009 XXX -XX -9598 04/15/2010 05/15/2020 3762.06
1040 12/31/2010 XXX -XX -9598 11/19/2012 12/19/2022 8411.42
Place of Filing
Prothonotary
Cumberland County Total $ 12173.48
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 31st day of December 2013
Signature �4—� Title
ACS W &I 11 -00 -0000
for DEANN BENDER (800) 829 -7650
(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)(0 (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X