HomeMy WebLinkAbout10-3855Form 668 M(c)
(Rev. February 2004)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien Igo Id , 3 8-5-5- f-n
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 662707910 0 o J
As provided by section 6321, 6322, and 6323 of the Internal Revenue o
Code, we are giving a notice that taxes (including interest and penalties) ?"?
have been assessed aphist 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
property belonging to this taxpayer for the amount of these taxes, and
additional penakies, interest, and costs that may accrue. C
Name of Taxpayer CENTRAL PENNSYLVANIA PULMONARY eti
ASSOCIATES LLC CLARK TIMOTHY A SOLE ME MBER
"
Residence 2250 MILLENIUM WAY STE 400
ENOLA, PA 17025-1488
flFi.6D
IMPORTANT RELEASE INFORMATION: For each assessment listed below, C40 1Q5-1 j
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
o ?? zw7 S-y 7
n I 63251a1.
i
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refs of Assessment
(a) b (c (d) a (f)
941 09/30/2009 56-2382216 01/11/2010 02/10/2020 34253.85
941 12/31/2009 56-2382216 04/26/2010 05/26/2020 89503.01
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $
This notice was prepared and signed at
the 02nd day of June
DETROIT, MI
123756.86
2010
, on this,
Signature A ?Yti Title
REVENUE OFFICER 22-06-1441
for DENNIS P ZMUDZIN (717) 777-9624
(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 Raecordhig Office CAT. 668(l (Rev. 2 20041
CAT. NO 60025X