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3355
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. February 2004)
Notice of Federal Tax Lien
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Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 U ~8tJ
Lien Unit Phone: (800) 829-3903 351606207 rei. I~ · jlj..tJ()
As provided by section '6321, 6322, and 6323 of the Internal Revenue Ck.. /.2 3 J 3
Code, we are giving a notice that taxes (including Interest and penalties)
have been assessed against the following-named taxpayer. We have made ~ / q 0 I., t '1
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.
Name of Taxpayer HEALTHCORE OF OHIO LLC
BAER KRISTA MEMBER
Residence
17 E MAIN ST
CARLISLE, PA 17013
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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,
on the day following such date, operate as a certificate of release as defined
in lAC 6325(a).
Kind of Tax:
(a)
940
941
Tax Period
Ending
(b)
12/31/2005
12/31/2005
Identifying Number
(c)
45-0508060
45-0508060
Date of
Assessment
(d)
10/30/2006
10/02/2006
Last Day for
Refiling
(e)
11/29/2016
11/01/2016
Unpaid Balance
of Assessment
(f)
379.44
14671. 04
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
15050.48
This notice was prepared and signed at
DETROIT, MI
, on this,
the
15 th day of March
2007
Signature
Title
ACS
(800) 829-3903
22-00-0008
f REGINA OWENS
(HOTE: 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 668(Y)(c) (Rev. 2-2004)
CAT. NO 60025X