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Department of the Treasury - Internal Revenue Service
Form 668 (Yj(c)
(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 991581014
As provided by section 6321, 6322, and 6323 of the Internal Revenue H
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 C7
property belonging to this taxpayer for the amount of these taxes, and 3 .z.= -
additional penalties, interest, and costs that may accrue. � � , T -
Name of Taxpayer THOMAS J & VALINDA L CUSTER.
wC -
Residence 20 CARLISLE RD APT 4_
NEWVILLE, PA 17241 -9745
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70inlRC ORTANT RELEASE INFORMATION For each assessment listed below,
ss notice of the lien is refilled by the date given in column (e), this notice shall,, �•
he day following such date, operate as a certificate of release as defined
6325(a).
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 12/31/2012 XXX -XX -6903 06/03/2013 07/03/2023 3577.29
Place of Filing
Prothonotary
Cumberland County Total $ 3577.29
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 27th day of March 2014
Signature /^�-�{ 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