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Department of the Treasury Internal Revenue Service
Form 66ar (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 745051811 if ?- I
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As provided by section 6321, 6322, and 6323 of the Internal Revenue I j
Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made n
a demand for payment of this liability, but It remains unpaid. Therefore, rrIc o
there Is a lien In favor of the United States on all property and rights to :Z :*W -
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property belonging to this taxpayer for the amount of these taxes, and v
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additional penalties, interest, and costs that may accrue. te
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Name of Taxpayer CENTRAL PENNSYLVANIA PULMONARY 3> ? 3 M.
ASSOCIATES LLC CLARK TIMOTHY A SOLE ME
MBER ,
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Residence 2250 MILLENIUM WAY STE 400 --4" 0-1
ENOLA, PA 17025-1488
NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall,
F `'
following such date, operate as a certificate of release as defined GG
RC
5(a).
Tax Period Date of La st Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e)
941 09/30/2010 56-2382216 12/27/2010 01/26/2021 61500.84
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 61500.84
This notice was prepared and signed at DETROIT, MI
the 20th day of January 2011 , on this,
Signature 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) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X