HomeMy WebLinkAbout10-4636Department 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 674118710
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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 N
property belonging to this taxpayer for the amount of these taxes, and "
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additional penalties, interest, and costs that may accrue. C-- --a -ro
Name of Taxpayer KENNETH R ROUSH
Residence 14 PARADISE DR
CARLISLE, PA 17015-9725 N
RTANT RELEASE INFORMATION: For each assessment listed below,
notice of the lien is refilled by the date given in column (e), this notice shall,
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day following such date, operate as a cert
6325(a).
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Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilli ng of Assessment
(a) (b) (c) (d) (e) M
1040 12/31/2009 XXX-XX-9812 05/31/2010 06/30/2020 14688.34
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 14688.34
This notice was prepared and signed at
the 02nd day of July
DETROIT, MI
2010
, on this,
Signature -yh ? Title
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. Rut. 71-466, 1971 - 2 C.B. 409)
Part I - Kept By Recording Office CAT. 668( (Rev. )
CAT. NO 60025X
025X