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Department of the Treasury - Internal Revenue Service
Form 1668 (Y)(c)
(Rev.February 2044) 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 126277014
As provided by section 6321, 6322, and 6323 of the Internal Revenue H_ 63-1
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, c
there is a lien in favor of the United States on all property and rights to -03 �- {
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue,
�-- = C.:;
Name of Taxpayer JORDAN GOLOBy
C X- CD-n
c y C.)
Residence 1200 MARKET ST SUITE 186
LEMOYNE, PA 17043-1417 cn
IMPORTANT RELEASE INFORMATION: For each assessment listed below, T,.
unless notice of the lien is refiled by the date given in column (e), this notice As]hall, 5� ,� G%> /
on the day following such date, operate as a certificate of release as defined
in IRC 6325{a}. �f� 3
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 12/31/2012 XXX-XX-5373 11/18/2013 12/18/2023 14017. 50
Place of Filing
Prothonotary
Cumberland County Total $ 14017 . 50
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 22nd day of October 2014
Signature r'�\r-� _ REVENUE OFFICER 22-06-2614
for LINDSEY O BOWLIN (717) 777-9623
(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)
Farm bb$( (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT, NO 60025X