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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) 913 -6050 968050213 _
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. -u - w
rn STEPHEN C SHILEY 2r
Name of Taxpayer
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Cn r--- '%r
"C b is1
Residence 410 S HIGH ST *= -r
MECHANICSBURG PA 17055 -6430
[ion : Sse TANT RELEASE INFORMATION: For each assessment listed below, CD -.:j otice of the lien is refiled by the date given in column (e), this notice shall,
day following such date, operate as a certificate of release as defined p
325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2009 XXX -XX -1435 05/20/2013 06/19/2023 7820.84
1040 12/31/2010 XXX -XX -1435 05/20/2013 06/19/2023 17021.18
Place of Filing
Prothonotary
Cumberland County Total $ 24842.02
Carlisle, PA 17013
This notice was prepared and signed at DE M I
on this,
the 07th day of November 2013
Signature REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777 -9621
(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( CAT (Rev. 025X )
Part 1 - Kept By Recording Office
CAT. NO 60025X