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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 #3
Lien Unit Phone: (800) 913 -6050 994690914
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, C's cT
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 rncO ;r- Fri
additional penalties, interest, and costs that may accrue. = �
Name of Taxpayer MISHA J DOUGHTY
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Residence 33 E LOCUST ST C:) C=
MECHANICSBURG, PA 170.55 -3839 ___ c-n
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, ��` . �Q . j
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). 1W .30 769P
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Re filing of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2010 XXX -XX -7621 12/23/2013 01/22/2024 13862.70
Place of Filing
Prothonotary
Cumberland County Total $ 13862.70
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI
on this,
the 11th day of April 2014
Signature Title
ACS SBSE 23 -00 -0001
for G.J. CARTER -LOUIS (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 t -Kept By Recording Office CAT. NO 60025X