T1874
Department of the Treasury - Internat Revenue Service
Form 668 (¥)(¢)
‘ev. February 20081 Notice of Federal Tax Lien
Area: Serial Number For Optionst Use by Recording Office,
SMALL BUSINESS/SELF EMPLOYED AREA #1
Lien Unit Phone: (860) 829-3903 978940314
As provided by section 6321, 6322, and 6323 of che 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 unpald. Therefore,
there is a llen in favor of the Uniced States on all property and rights to
property belonging to this taxpayer for che amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer EARL & CHARMAYNE P VAN WORMER IIT
Schoharie County Clerk
Document, Humber €B085
Bewd 01/27/2014
ft
Residence 1498 STATE ROUTE 30A CH. ee.
SLOANSVILLE, NY 12160-2705
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
lnless notice of the jen is refiled by the date given in con (el, this notice shall,
fon the day folowing such date, operate as 2 corticate of release a8 defined
in IRC 6326(a).
Tax Period Date of Unpaid Balance
Ending | Identifying Number of Assessment
fa) (b) {) (4) fe) ()
1040 [12/31/2009| xxx-xx-0880 [05/31/2010| 06/30/2020 4908.31
1040 [12/31/2010] xxx-xx-0880 |12/12/2011| 01/11/2022 6486.95
1040 12/31/2011] xxx-xx-0880 [05/28/2012] 06/27/2022 9930.34
1040 [12/31/2012] Xxx-xx-0880 |06/03/2013] 07/03/2023 13118.81
Place of Filing
SCHOHARIE COUNTY CLERK
SCHOHARIE COUNTY Total |$ 3444.43
SCHOHARIE, NY 12157
This notice was prepared end signed at ____MANHATTAN, N¥ on this,
the 26th gay January 2014
Sanatre Ce R&S spsz 21-00-0008
for P.A. BELTON
(NOTE: Coritioate of tice
Rov. Rul. 71-486, 1971 -2C.8, 408),
Part 2 - Internal Revenue Service TDA Copy
(800) 829-3903
thorized by law to take scknowladgment is not eseenial to tho valdlty of Novos of Federal Tax len
Form 668(¥)(c) (Rev. 2.2004)
‘CAT. NO 60025%