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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS /SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829 -3903 962311413
As provided by section 6321, 6322, and 6323 of the 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 unpaid. Therefore,
there is a lien in favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and —�
additional penalties, interest, and costs that may accrue. X � r r >> r r
.�J 3
Name of Taxpayer MATTHEW S SHUE_.
r5
Residence 929 FORBES RD
CARLISLE, PA 17013 -1722 c:: CD
E9inl :da' NT RELEASE INFORMATION For each assessment listed below, i
e of the lien is refiled by the date given in column (e), this notice shall,
following such date, operate as a certificate of release as defined / / 5(a). f2W" X6131
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2007 XXX -XX -9346 08/09/2010 09/08/2020 1054.58
1040 12/31/2009 XXX -XX -93.46 02/27/2012 03/29/2022 6153.29
1040 12/31/2011 XXX -XX -9346 05/20/2013 06/19/2023 6526.20
Place of Filing
Prothonotary
Cumberland County Total $ 13734.07
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 20th day of September 2013
Signature ��{ ACS SBSE 22 -00 -0001
for P.A. BELTON 1 (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) Form 668(Y)(c) (Rev. 2 -2004)
Part 1 - Kept By Recording Office CAT. NO 60025X