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Department of the Treasury - Internal Revenue Service
Form 668 (Y) Notice of Federal Tax Lien
(Rev. February 2004) 4)
Area: Serial Number For Optional Use by Recording Of fice
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829 -7650 996071814
As provided by section 6321, 6322, and 6323 of the Internal Revenue /yam ���9 P" G
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 rnc. F' F
2 70 -- J r -;
property belonging to this taxpayer for the amount of these taxes, and x-
additional penalties, interest, and costs that may accrue. u'y.
Name of Taxpayer TAMMY A WORTHERLEY �n �,► ms -,
Tm C
ZG G
Residence 243 W COLUMBIA RD APT 7
ENOLA, PA 17025 -2257
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 ;W
in IRC 6325(a). 3 0_S/oZ4
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 12/31/2009 XXX -XX -3935 10/29/2012 11/28/2022 2139.95
1040 12/31/2010 XXX -XX -3935 08/13/2012 09/12/2022 10474.87
1040 12/31/2010 XXX -XX -3935 08/13/2012 09/12/2022
Place of Filing
Prothonotary
Cumberland County Total $ 12614.82
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 22nd day of April 2014
Signature - 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