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Department of the Treasury - Internal Revenue Service
Farm 66ar (Y)(c)
(Rev.February 2044) Notice of Federal Tax Lien
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (840) 913-6050 136268614
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. r°r-,) `-
Name of Taxpayer SHANNON A BLACKCn
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Residence 233 BOOZ RD
SHIPPENSBURG, PA 17257-9726 ,
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall, '21
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a). r t--
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending identifying Number Assessment Refiliing of Assessment
(a) (b) (c) (d) (e) (f)
6672 06/30/2012 XXX-XX-2353 03/10/2014 04/09/2024 17953 . 00
6672 12/31/2012 XXX-XX-2353 03/10/2014 04/09/2024 3699 . 09
6672 06/30/2013 XXX-XX-2353 03/10/2014 04/09/2024 4489 . 56
Place of Filing
Prothonotary
Cumberland County Total $ 26141.65
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 23rd day of December 2014
Signature &k�t+ Title
REVENUE OFFICER 22-06-2614
for LINDSEY O BOWLIN (717) 777-9623
(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)
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