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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(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 996341714
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) d.
have been assessed against the following-named taxpayer. We have made = � -
a demand for payment of this liability, but it remains unpaid. Therefore, --D3 r x —,,
there is a lien in favor of the United States on all property and rights to rnw �
property belonging to this taxpayer for the amount of these taxes, and is
additional penalties, interest, and costs that may accrue. ��x> fv -'�
Name of Taxpayer CLARENCE H HEINLY <CD -a ca-7-1`
T, n =7:
T CD
C
Residence PO BOX 1143 Z
MECHANICSBURG, PA 17055-1143 _r
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,
on the day following such date, operate as a certificate of release as defined ��"S� ��` 6'
in IRC 6325(a). 3�S
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2012 XXX-XX-4955 03/24/2014 04/23/2024 4714 . 63
Place of Filing
Prothonotary
Cumberland County Total $ 4714 . 63
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 23rd day of April 2014
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.B. 409)
Form 668( I
Part 1 - Kept By Recording Office CAT. NO
600025X25X ►
CAT