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Department of the Treasury - Internal Revenue Service
F°n" brua (Y)(`)
Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 676132310
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) ® ? 7
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have been assessed against the folbwing-named taxpayer. We have made c
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a demand for payment of this liability, but it remains unpaid. Therefore, r-° -
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 CD
additional penalties, interest, and costs that may accrue.
Name of Taxpayer UNCLE NICKS DINER INC, a Corporation - ,- _
$s GABRIEL TSOUKALIS -c-
Residence PO BOX 490
NEW CUMBERLND, PA 17070-0490
LEASE INFORMATION: For each assessment listed below,
lien is refiled by the date given in column (e), this notice shall,
=
g such date, operate as a certificate of release as defined
6325(a).
-?
Tax Period Date of Last D for Unpaid Balance
Kind of Tax En
ding
Identifying Number
Assessment
Ref ing
of Assessment
(a) (b) (c) (d (e) (f)
940 12/31/2008 20-8686499 08/31/2009 09/30/2019 244.27
941 12/31/2008 20-8686499 08/24/2009 09/23/2019 3119.65
941 03/31/2009 20-8686499 01/04/2010 02/03/2020 1996.05
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 5359.97
This notice was prepared and signed at
DETROIT, MI
the 09th day of July 2010
, on this,
Signature A \I tt Title
ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
(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 CAT. 66a( (Rev. 2 2004)
CAT. NO 60025X