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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) 913-6050 119058714
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, El
_
there is a lien in favor of the United States on all property and rights to - -=-
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property belonging to this taxpayer for the amount of these taxes, and =M `. q'
additional penalties, interest, and costs that may accrue. r-
Name of Taxpayer RUBEN MOORE y :Z`
c-,r
Residence 407 SCOTT DR
SHIPPENSBURG, PA 17257-2168 ry
E
TANT RELEASE INFORMATION: For each assessment listed below,
otice of the lien is refiled by the date given in column (e), this notice shall,
day following such date, operate as a certificate of release as defined6325{a},
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 12/31/2002 XXX-XX-1342 103/14/2005 04/13/2015 520 .45
1040 12/31/2003 XXX-XX-1342 12/17/2007 01/16/2018 9094 . 17
1040 12/31/2005 XXX-XX-1342 12/08/2008 01/07/2019 3745 .53
Place of Filing
Prothonotary
Cumberland County Total $ 13360 . 15
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 09th day of September 2014
Signature Title
\� �C_.�s►.�r_ 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)
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