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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(R
F
b Notice of Federal Tax Lien
ev.
e
ruary 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOY D AREA #2
Lien Unit Phone: (800) 913-605 666546910
TL
As provided by section 6321, 322, and 6323 of the Internal Revenue / 0 "i!D7?
Code, we are giving a notice t t taxes (including interest and penalties)
have been assessed against the ollowing-named taxpayer. We have made
a demand for payment of this bility, but it remains unpaid. Therefore,
there is a lien in favor of the nited States on all property and rights to
property belonging to this er for the amount of these taxes, and n
additional penalties, interest, a costs that may accrue. Q
w C
-
Name of Taxpayer RESTORATIO
N CLINIC INC, a Corporation _
[J
m
Residence 827 W TRI LE RD
MECHANICS URG, PA 17055-4058 4.;` =r
IMPORTANT RELEASE INFO NATION: For each assessment listed below, C?
=<
unless notice of the lien is refiled b
on the da
followin
on
s
h d
t the date given in column (e), this notice shall,
t
ifi X9,00
? c
,
:
?.
y
g
uc
a
e, pera
e as a cert
cate of release as defined j
IRC 6325(a). o'? y$333
Tax Period Date of Last D for Unpaid Balance
Kind of Tax Ending 1 ntifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e (f)
1120 12/31/2008 74-3075317 01/04/2010 02/03/2020 534.00
Place of Filing
Prothono tary
Cumberla nd County Total $ 534.00
Carlisle , PA 17013
This notice was prepared and sign ed at DETROIT, MI on this
,
,
the 11th day of June 2010
Signature A Title
REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(NOTE: Certificate of officer au?
Rev. Rul. 71-466, 1971 - 2 C.B.
by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Part 1 - Kept Form 668(Y)(c) (Rev. 2-2004)
BY Recording Office CAT. NO 60025X