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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(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 998506914
As provided by section 6321, 6322, and 6323 of the Internal Revenue '01:-w
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 g .
property belonging to this taxpayer for the amount of these taxes, and :Zrr,CQ
M
additional penalties, interest, and costs that may accrue.
Name of Taxpayer RAFAEL D & DALIA COLLADO -<> w C"'
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C- C
Residence 975 HUMMEL AVE
LEMOYNE, PA 17043-1738
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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unless notice of the, lien is refiled by the date given in column (e), this notice shall,
notice
P 0� C
le s
I� s
on the day following such date, operate as a certificate of release as defined
i I the y
on IRC 6 3 2 5(a). ,tQ74# 30S
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d)- (e) M
1040 12/31/2010 XXX-XX-1446 07/08/2013 08/07/2023 43506 . 85
1040 12/31/2011 XXX-XX-1446 07/08/2013 08/07/2023 44818 .39
1040 12/31/2012 XXX-XX-1446 12/02/2013 01/01/2024 56024 . 94
Place of Filing
Prothonotary
Cumberland County Total 144350 . 18
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 06th day of May 2014.
Signature Title
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 t -Kept By Recording Office CAT. NO 60025X