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Department of the Treasury - Internal Revenue Service
Form 66ar cY)(`)
(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 958748713
/3
As provided by section 6321, 6322, and 6323 of the Internal Revenue
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 r n co crn _
additional penalties, interest, and costs that may accrue. = � � j f
r-
Name of Taxpayer CLARENCE H HEINLY -< >
CD
Residence PO BOX 1143 ..;
MECHANICSBURG, PA 17055 -1143
FRC NT RELEASE INFORMATION: For each assessment listed below,
e of the lien is refiled by the date given in column (e), this notice shall, -2 ,SZ)
following such date, operate as a certificate of release as defined p
5(a).
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Re filing of Assessment
(a) (b) (c) (d) (e) (f)
.1040 12/31/2002 XXX -XX -4955 11/08/2004 12/08/2014 4256.61
1040 12/31/2003 XXX -XX -4955 09/17/2012 10/17/2022 928.89
1040 12/31/2004 XXX -XX -4955 09/10/2012 10/10/2022 615.71
1040 12/31/2005 XXX -XX -4955 10/01/2012 10/31/2022 1178.11
1040 12/31/2006 XXX -XX -4955 10/01/2012 10/31/2022 1956.78
1040 12/31/2007 XXX -XX -4955 01/07/2013 02/06/2023 5597.19
1040 12/31/2008 XXX -XX -4955 01/07/2013 02/06/2023 4810.61
1040 12/31/2009 XXX -XX -4955 12/31/2012 01/30/2023 685.85
1040 12/31/2011 XXX -XX -4955 09/03/2012 10/03/2022
1040 12/31/2011 XXX -XX -4955 08/05/2013 09/04/2023 5793.60
Place of Filing
Prothonotary
Cumberland County Total $ 25823.35
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 04th day of September 2013
Signature Title
�-� REVENUE OFFICER 22 -06 -1413
for LINDSEY O BOWLIN (717) 777 -9623
(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.S. 409)
AT
Part 1 - Kept By Recording Office Form 668( C (Rev. 2 -
CAT. NO 60025X X