HomeMy WebLinkAbout10-3708Form 668 (Y)(c)
(Rev. February 2004)
4804
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien No. fo - 3 70 S--, FTI-
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 661049310 _
As provided by section 6321, 6322, and 6323 of the Internal Revenue C7 °- y
Code, we are giving a notice that taxes (including interest and penalties) ro? s-
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore, 15 f i:"
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 C r•:
additional penalties, interest, and costs that may accrue. C , M
Name of Taxpayer RESTORATION CLINIC INC, a Corporation Z
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Residence 827 W TRINDLE RD ra y- a4 14
MECHANICSBURG, PA 17055-4058 cl&?0376
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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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 IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) (d) (e)
940 12/31/2006 74-3075317 07/27/2009 08/26/2019 88.77
941 12/31/2006 74-3075317 07/27/2009 08/26/2019 12753.92
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 12842.69
This notice was prepared and signed at
the 27th day of May
DETROIT, MI
2010
, on this,
Signature -)? A ?Y ? 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. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X