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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: (boo) 913-6050 124547214
As provided by section 6321, 6322, and 6323 of the Internal Revenue (1130 /=7Z-
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 demand for payment of this liability, but it remains unpaid. Therefore, 3 -r
there is a lien in favor of the United States on all property and rights to rncD C3
property belonging to this taxpayer for the amount of these taxes, and z� ---I
additional penalties, interest, and costs that may accrue. r — X
.�> .,� Q
Name of Taxpayer JOHN D BUCKWALTER r"
JOHN D BUCKWALTER DRAPERIES DQ
CO r:
Residence 30 N STH ST rr H
LEMOYNE, PA 17043-1610
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, te,
on the day following such date, operate as a certificate of release as defined � ry
1- od- G 7"
in IRC 6325(a).
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)
940 12/31/2011 23-2218095 05/07/2012 06/06/2022 557 . 07
941 12/31/2011 23-2218095 04/09/2012 05/09/2022 9479 . 64
Place of Filing
Prothonotary
Cumberland County Total $ 10036 . 71
Carlisle, PA 17013
This notice wasre ared and signed at DETROIT, MI
p P 9 , on this,
the 10th day of October 2014
Signature Title
REVENUE OFFICER 22-06-2625
for MIGNA RODRIGUEZ (717) 777-9622
(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 t -Kept By Recording Office CAT. NO 60025X