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Department of the Treasury - Internal Revenue Service
Form 66$ (Y)(`)
(Rev. February 2004) Notice of Federal Tax Lien
4
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #1
Lien Unit Phone: (800) 913-6050 107896114
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 C-
-
property belonging to this taxpayer for the amount of these taxes, and M cz c_.-
additional penalties, interest, and costs that may accrue.
Name of Taxpayer DAVID PIATT II & JENNIFER PIATT —.
Residence 104 RUSTIC DR
SHIPPENSBURG, PA 17257-8750 :, y'
.:
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
in IRC 6325(a), fp -/Z 4,
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2013 XXX-XX-6726 06/02/2014 07/02/2024 15122 .48
Place of Filing
Prothonotary
Cumberland County Total $ 15122 .48
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 02nd day of July 2014.
Signature / Title
���. �.. ACS SBSE 21-00-0008
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