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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 998765114
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 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
additional penalties, interest, and costs that may accrue. rTj
Name of Taxpayer ROBERT A DOUGHERTY
cn r' D
Oti -c`D
Residence 532 W ELMWOOD AVE D c7
MECHANICSBURG, PA 17055-4018
E
TANT RELEASE INFORMATION: For each assessment listed bella4
ative of the lien is refiled by the date given in column {e} this notice sday following such date, operate as a certificate of release as defi325(a). 3U.S'7-�17
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2008 XXX-XX-8709 08/06/2012 09/05/2022 13264 .62
1040 12/31/2009 XXX-XX-8709 08/06/2012 09/05/2022 2484 . 59
Place of Filing
Prothonotary
Cumberland County Total $ 15749 .21
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 07th day of May 2014
Signature / Title
\C--�-�- 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 8y Recording Office CAT, NO 60025X