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1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) }(.() 0 &. /1/% r-TL
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 & I?t;f "IVI'/;
lien Unit Phone: (800) 829-3903 280948106
As provided by section 632., 6322, and 6323 of the Internal Revenue ('Jr... /0 ((11.-
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made jJ J 7(..333
a demand for payment of this liability, but it remains unpaid. Therefore, L<. .
there is a lien in favor of the United States on all property and rigbts to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue. "'"'
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Name of Taxpayer STEVEN J MOTTER r:::::) -.1
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Residence I (7;
PO BOX 213 w c'
WALNUT BOTTOM, PA 17266-0213 ,
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IMPORTANT RILEASE INFORMATION: For each assessment listed below, 1'-.) 1"11
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 ,-
C",
in IRC 63251a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refihng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12(31(2004 XXX-XX-6816 05(30(2005 06(29(2015 4703.55
Place of Filing
Prothonotary
Cumberland County Total $ 4703.55
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
. on this,
the
24th day of March
2006
for REGINA OWENS
Title
ACS
(800) 829-3903
22-00-0008
Signature
(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. 4091
Part t - K~t By Recording Office
Form 668(Y)(c) {Rev, 2-20041
CAT. NO 60025X