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Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Form 668 (Y)(c)
(Rev. October 2000)
Area:
SMALL BUSINESS/SELF EMPLOYED AREA ~3
Lien Unit Phone: (412) 395-5265
Serial Number
230179717
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are ~ving 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
For Optional Use by Recording Office
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer RESTORATION CLINIC , a Corporation
Residence 827 W TRINDLE RD
MECHANICSBURG, PA 17055-4058
I in IRC 6325(a).
Tax Period
Kind of Tax Ending
(a) (b)
941 03/31/2001
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
Identifying Number
(c)
25-1645696
Date of
Assessment
(d)
06/04/2001
Last Day for
Retiring
(e)
07/04/2011
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total
Unpaid Balance
of Assessment
(f)
5500.95
5500.95
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the 07th day of September, 2001
Signature
for D. FISHER
Title
Revenue Officer
(717) 221-3490
23-01-1439
(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 &&8(Y)(c) (Rev. 10-00)
Par~ ! - Kept By Recording Office CAT. NO 60025X