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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 991566814
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 Gen in favor of the United States on all property and rights to E
property belonging to this taxpayer for the amount of these taxes, and -
additional penalties, interest, and costs that may accrue. r'n IM
Name of Taxpayer ROSS A DEYOUNG r I
C CD f
319A ROSEMONT AVE
Residence
NEW CUMBERLND, PA 17070 -1879
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). 303 %, 7
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f7
1040 12/31/2008 XXX -XX -5869 12/05/2011 01/04/2022 5557.99
1040 12/31/2010 XXX -XX -5869 12/05/2011 01/04/2022 7399.63 `
1040 12/31/2011 XXX -XX -5869 01/07/2013 02/06/2023 7069.18
Place of Filing
Prothonotary
Cumberland County Total $ 20026.80
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 27th day of March 2014
Signature T itle / -� CS 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)
Part 1 - Kept By Recording Office Form 668( CAT (Rev. 025X )
CAT. NO 60025X