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Department of the Treasury - Internal Revenue Service
Form 66ar (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) 829-3903 133239214
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 Cn
property belonging to this taxpayer for the amount of these taxes, and _ rt
additional penalties, interest, and costs that may accrue.
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Name of Taxpayer THOMAS J & VALINDA L CUSTERCD
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Residence
20 CARLISLE RD APT 4 3~-C) 1
NEWVILLE, PA 17241-9745 `
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(a). 3 t4-
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (0
1040 12/31/2013 XXX-XX-6903 06/09/2014 07/09/2024 4141 .77
Place of Filing
Prothonotary
Cumberland County Total $ 4141 .77
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 04th day of December 2014
Signature �?�(L %-/ 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. Rut. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office Form 66$(Y)(c) (Rev. 2^2004)
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