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Department of the.Treasury - Internal Revenue Service
Form 668 {Y)(c)
(Rev.February 2044) 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 996341814
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 Gen 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. -°
zrrrj t �
Name of Taxpayer CLARENCE H HEINLY III =:�a -»t -
HEINLY III �> CD
Residence PO BOX 1143 Wit '
C.
MECHANICSBURG, PA 17055 T> ,
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, -2,1
on the day following such date, operate as a certificate of release as defined >
in IRC 6325{a}, i6M :3 or 3.a�)
Tax Period Date of Last Da for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/2012 42-1551788 03/04/2013 04/03/2023 93 . 56
941 12/31/2012 42,-1551788 03/04/2013 04/03/2023 2227 .49
941 03/31/2013 42-1551788 09/23/2013 10/23/2023 681 .28
Place of Filing
Prothonotary
Cumberland County Total $ 3002 .33
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)
AT Form 668( (Rev.. NO 600025X25X)
Part i -Kept By Recording Office CAT.