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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
(Rev. February 20041
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 88 4863312 >aq?/ ??.
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and p enalties)
have been assessed against the following-named taxpayer. We ve made
a demand for payment of this liability, but it remains unpaid. refore,
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there is alien In favor of the United States on all property and is to -? r -?
property belonging to this taxpayer for the amount of these es, and c ? r-
-
additional penalties, Interest, and costs that may accrue. e? rs -
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Name of Taxpayer KENNETH H & BELLA M RANDOLPH r5
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Residence
PO BOX 323 _
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CARLISLE, PA 17013-0323
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IMPORTANT RELEASE INFORMATION: For each assessment liste d below,
unless notice of the lien is refiled by the date given in column (e), this not ice shall,
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on the day following such date, operate as a certificate of release a defined 7
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in IRC 6325(a). .
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Tax Period Date of Last Day for Unpaid Ba nce
Kind of Tax Ending Identifying Number Assessment Refigng of Assessm ent
(a) (b) c) (d (0) M
1040 12/31/2007 XXX-XX-6138 04/15/2008 1 05/15/2018
1040 12/31/2007 XXX-XX-6138 10/05/200 11/04/2019
1040 12/31/2007 XXX-XX-6138 05/09/201 06/08/2021 230 9.62
1040 12/31/2008 XXX-XX-6138 04/15/200 05/15/2019
1040 12/31/2008 XXX-XX-6138 10/05/200 11/04/2019
1040 12/31/2008 XXX-XX-6138 05/09/201 06/08/2021 513 8.19
1040 12/31/2009 XXX-XX-6138 11/29/201 12/29/2020
1040 12/31/2009 XXX-XX-6138 05/09/201 06/08/2021 105 6.99
1040 12/31/2010 XXX-XX-6138 12/26/201 01/25/2022 188 57.04
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Place of Filing
Prothonotary
Cumberland County Total $ 10378 1.84
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 30th day of July 2012
Signature Title
REVENU
E OFFICER 22-06
-1418
for JAKOB PEDERSEN (717) 77-9621
(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(Y)(c) (Rev 2-2004)
Part 1 - Kept By Recording Wilke CAT. NO 100251(