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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 976284113
As provided by section 6321, 6322, and 6323 of the Internal Revenue f
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following -named taxpayer. We have made r 3
a demand for payment of this liability, but it remains unpaid. Therefore, t
there is a lien in favor of the United States on all property and rights to M C-- .-J -
property belonging to this taxpayer for the amount of these taxes, and i
additional penalties, interest, and costs that may accrue.
Name of Taxpayer AMBER E RUI Z RIVERA c. _
Residence : -�`_-�
351 N HANOVER ST
CARLISLE, PA 17013 -1928 -J
=63 25 (a). LEASE INFORMATION For each assessment listed below,
lien is refiled by the date given in column (e), this notice shall, /
ing such date, operate as a certificate of release as defined
3d� 31�
Tax Period Date of Last Day for unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2011 XXX -XX -9598 05/28/2012 06/27/2022 176.35
Place of Filing
Prothonotary
Cumberland County Total $ 176.35
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 31st day of December 2013
Signature /-�1� 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)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X