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11883
Department of the Treasury -Internal Revenue Service
Form 668 (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} 913-5050 888938912
As provided by section 6321, 6322, and 6323 of the Internal Revenue ~ S
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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,
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there is a lien in favor of the United States on all property and rights to c
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property belonging to this taxpayer for the amount of these taxes, and ~
additional penalties, interest, and costs that may accrue. ~ ~ ~ w~~~
Name of Taxpayer CENTRAL PENNSYLVANIA PULMONARY ~ fir-
ASSOCIATES LLC CLARK TIMOTHY A SOLE ME BER q~p
a Cor oration r"'~'
Residence 156 CUMBERLAND PARKWAY SUITE 100 ~
MECHANICSBURG, PA 17055-0000 y,,C:;: s7~ ~r'~--,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall, S Za ~~~x! ~ c!- r
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a}. ~/J~,~ " 'r
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Tax Period Date of Last Dayy for Unpaid Bal nce
Kind of Tax Ending Identifying Number Assessment Refiling of Assess~ent
(a) (b) (c) (d) (e) (f)
941 12/31/2010 56-2382216 08/06/2012 09/OS/2022 572!98.78
Place of Filing
Prothonotary
Cumberland County Total $ 5728.78
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 20th day of August 2012
Signature r";~~ RIEVENUE 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 tFre validity of Notice of Federal Ta lien
Rev. Rul. 71-466, 1971 - 2 C.E.. 409) Form 668(Y)(e) (Rev. 2-20041
Part t -Kept By Recording Office CAT. NO 60025X