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Department of the Treasury - Internal Revenue Service
(Rev,February 20004)4)
Form 66ar (YNotice 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 120961514
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 va -= -.-
additional penalties, interest, and costs that may accrue. =M
Name of Taxpayer MICHAEL R & AIDA L STATON F ' =
> �
r— - tP
Residence 4 RASPBERRY DR - .
MECHANICSBURG, PA 17050-2792 .
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, /,a� /cad
on the day following such date, operate as a certificate of release as definedt/� � .
in IRC 6325(a). 2�41
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 12/31/2010 XXX-XX-0472 04/25/2011 05/25/2021
1040 12/31/2010 XXX-XX-0472 04/28/2014 05/28/2024 11107.42
Place of Filing
Prothonotary
Cumberland County Total $ 11107 .42
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 18th day of September 2014
Signature ACS W&I 11-00-0000
for DEANN BENDER {800) 829-7650
(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