HomeMy WebLinkAbout12-4006Form 668 (Y)(c)
(Rev. February 2004)
480
Department of the Treasury - Internal Revenue Service
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 875631712
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As provided by section 6321, 6322, and 6323 of the Internal Revenue 'yG
Code, we are giving a notice that taxes (including. Interest and penalties)
have been assessed against 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
penalties, interest, and costs that may accrue.
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CENTRAL PENNS
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axpayer
NIA PULMONARY
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ASSOCIATES LLC CLARK TIMOTHY A SOLE ME MBER --.[c:)
Residence 2250 MILLENNIUM WAY STE 400 Zq pc
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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,
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ar
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following such date, operate as a certificate of release as defined '? ?-
IRC
5(a). ?? 72H3
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) f)
941 03/31/2011 56-2382216 06/04/2012 07/04/2022 133947.74
941 06/30/2011 56-2382216 06/04/2012 07/04/2022 122314.32
941 09/30/2011 56-2382216 06/04/2012 07/04/2022 138561.30
941 12/31/2011 56-2382216 06/04/2012 07/04/2022 127041.67
Place of Filing
Total 1$ 521865.03
This notice was prepared and signed at
the 18th day of June
DETROIT, MI
2012
, on this,
Signature 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
Prothonotary
Cumberland County
Carlisle, PA 17013