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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 126265514 !
As provided by section 6321, 6322, and 6323 of the Internal Revenue P/
/
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 r-,,
property belonging to this taxpayer for the amount of these taxes, and `=
additional penalties, interest, and costs that may accrue. rncu o -
C--
Name of Taxpayer LISA MATUKAITIS
�r... �r>
CD
Residence s� CD
6 O 1 DEVON RD D� � c.:�-,•;
CAMP HILL, PA 17011-1621
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(x). Oft 312W
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 12/31/2011 XXX-XX-3438 11/19/2012 12/19/2022 24768 .49
1040 12/31/2012 XXX-XX-3438 11/18/2013 12/18/2023 24786 .26
Place of Filing
Prothonotary
Cumberland County Total $ 49554 . 75
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 22nd day of October. 2014
Signature �'\� 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 1 - Kept By Recording Office CAT. NO 60025X