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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) 829-3903 119355314 Ji�i_s�- 7,j �✓��
As provided by section 6321, 6322, and 6323 of the Internal Revenue 77 a /-
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made c a
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 tornc�
property.belonging to this taxpayer for the amount of these taxes, and 1
additional penalties, interest, and costs that may accrue. Or). --- C:D
Name of Taxpayer PETER M & KATHRYN A STAGGS 3
k
Residence 65 JAMESTOWN RD �-
SHIPPENSBURG, PA 17257-9148
70inIRC
ORTANT RELEASE INFORMATION: For each assessment listed below,
s notice of the lien is refiled by the date given in column (e), this notice shall, a/J� ��
e day following such date, operate as a certificate of release as defined '
6325{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 12/31/2010 XXX-XX-9648 05/30/2011 06/29/2021 38383 . 87
1040 12/31/2011 XXX-XX-9648 11/19/2012 12/19/2022 487 .34
1040 12/31/2012 XXX-XX-9648 11/18/2013 12/18/2023 79233 .65
Place of Filing
Prothonotary
Cumberland County Total $ 118104 . 86
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI
on this,
the lith day of September, 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 I -Kept By Recording Office CAT. NO 60025X