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%