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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) 913-6050 132623514
As provided by section 6321, 6322, and 6323 of the Internal Revenue -70a,3
Code, we are ginning 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. -r
Name of Taxpayer TIMOTHY A CLARK
Y s
Residence PO BOX 670
MINERSVZLLE, PA 17954 I'«
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, G
on the day following such date, operate as a certificate of release as defined 'n's� p�`
in IRC 6325(a). 41 jf/
Tax Period Date of Last Day for 7Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (f)
6672 12/31/2010 XXX-XX-5346 10/15/2012 11/14/2022 32861.62
6672 03/31/2011 XXX-XX-5346 10/15/2012 11/14/2022 81458 . 61
6672 06/30/2011 XXX-XX-5346 10/15/2012 11/14/2022 81458.61
6672 09/30/2011 XXX-XX-5346 10/15/2012 11/14/2022 81458 .61
6672 12/31/2011 XXX-XX-5346 10/15/2012 11/14/2022 81458.61
s
Place of Filing
Prothonotary
Cumberland County Total $ 358696 . 06
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 01st day of December 2014
Signature
&k"� Title
REVENUE OFFICER 22-06-2626
for ERIK STARK (717) 777-9655
(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
Part 1 -Kept By Recording Office Form 668( C (Rev. 2-2004)
CAT. NO 60025X