HomeMy WebLinkAbout06-0740
1872
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) f'Lc 0(, . 1<+0 r:-rL.
Area: Serial Number For Optional Use by ,Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2 ;~, f/(f · /1/. url
Lien Unit Phone: (800) 913-6050 270418406
As provided by section 6321, 6322, and 6323 of the Internal Revenue Ck l'lJl
Code, we are giving a notice that taxes (including interest and penalties) 17<f{J23
have been assessed against the following-named taxpayer. We have made J~.
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. (') ....,
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Name of Taxpayer RESTORATION CLINIC INC Corporation C~~~
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Residence 827 W TRINDLE RD I ;~~l?
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MECHANICSBURG, PA 17055-4058 -;:1 ~-~~.,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, r:;:> ,':..:.-"rn
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unless notice of the lien is refiled by the date given in column (e), this notice shall. - S'
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on the day folloWing such date, operate as a certificate of release as defined 0 --<
in IRe 6325(a).
Tax Period Date of Last Da.r. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref! 109 of Assessment
(a) (b) (c) (d) (e) (f)
941 09/30/2003 74-3075317 12/08/2003 01/07/2014 1282.71
941 12/31/2003 74-3075317 04/19/2004 05/19/2014 1359.50
941 06/30/2004 74-3075317 09/27/2004 10/27/2014 12046.94
941 09/30/2004 74-3075317 12/20/2004 01/19/2015 14610.46
941 12/31/2004 74-3075317 03/07/2005 04/06/2015 8764.24
941 03/31/2005 74-3075317 07/11/2005 08/10/2015 6055,29
941 06/30/2005 74-3075317 12/26/2005 01/25/2016 8359.88
941 09/30/2005 74-3075317 12/26/2005 01/25/2016 7849.77
Place of Filing
Prothonotary
Cumberland County Total $ 60328.79
Carlisle, PA 17013
This notice was prepared and signed at
DETROIT, MI
, on this,
the
25th day of January
2006
Signature /J- / /
'.,MJ(JtZAJ u- n~
for DAVID M. SHROYER
Title
REVENUE OFFICER
(717) 221-3490 x1320
22-06-1442
(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)
Part 1 - Kept By Recording Office
FQ,m 668(Y)(c) IRev. 2-20041
CAT, NO 60025X