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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(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 104246214 iy �,5
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, 7
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. rn
Name of Taxpayer KENNETH R ROUSH r
r C C:) CD
G Z-'-
Residencer�
14 PARADISE DR
CARLISLE, PA 17015-9725 X
E
TANT RELEASE INFORMATION: For each assessment listed below,
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
325(a). 3
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2012 XXX-XX-9812 06/03/2013 07/03/2023 14535 . 69
Place of Filing
Prothonotary
Cumberland County Total $ 14535 .69
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the lith day of June 2014
SignatureTitle
REVENUE OFFICER 22-06-2624
for JAKOB A 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( (Rev. 2-2004)
Part t -Kept By Recording Office CAT. NO 60025X