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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 115079214
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 ,
C-1
property belonging to this taxpayer for the amount of these taxes, and (-- _
additional penalties, interest, and costs that may accrue. rn� ,
Name of Taxpayer R RANDALL SCHMIDT �r,
cn C:)
--C ' un -
Residence 930 WILLSHIRE DR
MECHANICSBURG, PA 17050-2161 — C):
E
ORTANT RELEASE INFORMATION: Far each assessment listed below,
s notice of the lien is refiled by the date given in column (e), this notice shall, r'
e dayfollowing such date, operate as a certificate of release as definedC 6325(a).
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-9591 06/23/2014 07/23/2024 47413 . 31
1040 12/31/2013 XXX-XX-9591 06/21/2014 07/21/2024' 10963 . 68
Place of Filing
Prothonotary
Cumberland County Total $ 58376 . 99
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 14th day of August 2014
SignatureTitle
ACS SBSE 22-00-0001
for P.A. BELTON (800) 82.9-3903
(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)
Part 1 • Kept By Recording Office Form b68( CAT (Rev. 2 2004)
CAT. NO 60025X