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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 #2
Lien Unit Phone: (800) 913-6050 110459614
As provided by section 6321, 6322, and 6323 of the Internal Revenue 7 IC7�7_L
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.
Name of Taxpayer K C DILTZ & K M FOJUTOWSKI-DILTZ r m i -r-,
rn..-.
Ln CD
Residence 127 YORKSHIRE DR r�--�
MECHANICSBURG, PA 17055-3533 .Z a• CD
3>t-, -� f
Z p CD t
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). I/
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 12/31/2013 XXX-XX-8260 06/02/2014 07/02/2024 25676 . 19
Place of Filing
Prothonotary
Cumberland County Total $ 25676 . 19
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 18th day of July 2014
Signature Title
REVENUE OFFICER 22-06-2624
for JAKOB A PEDERSEN (717) 777-9621
(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)
AT
04)
Part 1 - Kept By Recording Office Form 668( C (Rev. 2 20
CAT. NO 60025XX