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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
FTL'
(Rev. February 2004) Notice of Federal Tax Lien 10-010135- 41 ?1-e m
Area Serial Number For Optional Use by Recording Office
SMAL L BUSINESS/SELF EMPLOYED AREA #2
Lien nit Phone: (800) 829-3903 632496510 *1q,00 Pp PUFF
As rovided by section 6321, 6322, and 6323 of the Internal Revenue e L* q&oq
Co e, we are giving a notice that taxes (including interest and penalties)
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ha been assessed against the following-named taxpayer. We have made
a d mand for payment of this liability, but it remains unpaid. Therefore,
the a is a lien in favor of the United States on all property and rights to
pro erty belonging to this taxpayer for the amount of these taxes, and C- -
ad itional penalties, interest, and costs that may accrue.
Nam of Taxpayer KENDRA J SHAFFER ? '
Resi ence 105 STEELSTOWN RD ZZI: -`'
NEWVILLE, PA 17241-9602
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1
PORTANT RELEASE INFORMATION: For each assessment listed below, c! t.. T7
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un ess 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).
Tax Period Date of Last Day for Unpaid Balance
Kin of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
040 12/31/2005 XXX-XX-6505 03/23/2009 04/22/2019 9581.31
1040 12/31/2006 XXX-XX-6505 03/23/2009 04/22/2019 3264.65
Place of Filing
Prothonotary
Cumberland County Total $ 12845.96
Carlisle, PA 17013
This (notice was prepared and signed at
the day of March
DETROIT, MI
, on this,
2010
Signture N ACS 22-00-0008
for MICHAEL W. COX (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. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office CAT. 668( (Rev. 2 2004)
CAT. NO 60025X