IRS Lien JUN- 12-2013 13 : 36 P . 001
ABLAr DEPARTMENT OF THE TREASURY
Internal Revenue Service
Small snsine s/Self mpioyed
II FAX COVER SI-IEET
CCP Liens
333 Scott St.
Stop 84200
Covington, KY 41011
Tot Italia Claxton From: L1ESY DEPARTMENT
Phone Phone number: 1-800-913-60S0
Fax 904-S67-1103 Date: 06/12/2013
Stop/Room Number: Number of Pages: 3
(including cover sheet)
Comments:
CON El O6NTlA111 V NOTICE
This communication is intended For the sole use of the individual to whom it is addressed and may contain
information that is privileged. confidential and exempt From disclosure under applicable law. 1F the reader of this
communication is not the intended recipient, or the employee or agent For the delivering the communication to the
intended recipient. yo a hereby n tified that ny dissemination, distribution, or opying of this cation is
strictly prohibited. IFy a havereceived this communication error, please tify, the sender immediately,by
telephone call, and return the communication to t the address above via the United States Postal Service. Thank you
JUN- 12-2013 13 : 36 P . 002
Internal Revenue Service flenartment of the Treasury
00/17/701S
145757m er.
SONJA G GROSS ROCOCO TO Contact:
2540 WHITE HORSE RU E JIMMY HENOERSON
JACKSONVILLE, FL 32246 Contact Iu mt.-niter:
icatio rvucr:
99-99999
Contact Te e ry u mbcr.
(SOO) 913-60S-OO 50
T erl identification Number.
We filed Notices) of Federal Tax Lien in OUVAL, FL relating to the
tax liabilities listed below .
SONJA G GROSS
331 SEMINOLE PO
ATLANTIC BEACH, FL 32233
T Tax identiffyyi•ng Name Unpaid Statutory Additions to: 07/ 10/2015
ofz TIFF Period NurnPAr Control Balance Interest Penalty Total
lone ao imimi/moos xxx-xx-aaaa osa . sz 53n . AM va co
°s
We also assessed the tax for the following periods but have not filed any liens.
v3 . ao
YP ng Name Unpaid Statntor r Additions tor 07/10/7013
o£ Tax MFT Period blumi er Control Balance Interest -Penalty Total
This letter may contain a second page listing additional tax liabilities.
The total a oust of your outstanding t liability (including additional interest and penalties) is
S7S73.6O The amount you need to pay to release the lien(s) 57573. G0 n We will
issue a Certificate of Release of Federal Tax Lien within SO days if you pay this amount by O7/1 O/2013 using
one of the following payment methods:
1 . Cash (presented at the local IRS office only)
2 . Certified or shier's check
a . Treasurer's check drawn on a m national/state bank or trust copany
4. Postal or bank money order.
A copy of this letter must mpany the payment in order to get an ed iate release. If the payment is made in
any other form or this letter i included . the release will be issued SO days after we e tine payment Or
receive we
notification that the funds have been transferred to the United States Treasury. For more information
regarding the different forms of payments, please visit our website at www . irs.gOV .
Make the check or money order payable to the United States Treasury. To properly apply the payment. please
write the full taxpayer identification number on this letter (in the upper right tinder Taxpayer Identification
Number) and on the payment check or money order. Mail tine payment and a corner of this letter t the address
provided below . You do not need to send the payment by express or certified mail; it will not impact the
processing of the payment. Keep a copy of this letter for your records
Page 1
Letter 364 • (Rev_ 2-2010)
JUN- 12-2013 13 : 36 P . 003
Rorer-oaf Revenue Service Mepartment of the Treasury
00/ 1 2/201 a
14S757m or.
SONJA G GROSS to Contact:
2540 WHITE HORSE RO E JIMMY HENIJERSON
JACKSONVILLE, FL 52246 Contact identification Number:
99-99999
Contact number:
0300) Si 91 S-6050
CONTINIL) - Page 2
Taxpayer llge6nt61N anon Nu ber.
m
Please send the payment and a copy of this letter to :
INTERNAL REVENUE SERVICE
STOP 5420-9
PO BOX 145595
CINCINNATI, OH 45250-5595
If you have any questions. please contact the person whose name and telephone number appear at the top of this
letter.
Sincerely.
Operations Manager, Centralized Case Processing-Lien Unit
Letter 3640 fame- 2-2010)
TOTAL P . 003