HomeMy WebLinkAbout10-5730Form 668 (Y)(c)
(Rev. February 2004)
11883
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number For Optional Us by Recording Office
SMALL.., BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 693527910 _ y-
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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,
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there is a lien in favor of the united States on all property and rights to -0t
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property belonging to this taxpayer for the amount of these taxes, and ', t
additional penalties, interest, and costs that may accrue. w
Name of Taxpayer CAPITAL CITY JEWELERS INC TAA
a Corporation ?? cr?
Re sMence 3401 HARTZDALE DR STE 131
CAMP HILL, PA 17011-7238
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
in IRC 6325(a). ?(r t?' 7Sy
Tax Period Date of Last Day for ; Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilling of Assessment
(a) (b) (c) d) (e) (f)
940 12/31/2009 03-0408672 04/26/2010 05/26/2020 104.07
941 03/31/2009 03-0408672 07/06/2009 08/05/2019 1226.90
941. 06/30/2009 03-0408672 09/21/2009 10/21/2019 2016.06
Place of Filing
Prothonotary
Cumberland County Total 3347.03
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI on this,
the 27th day of August 2010
Signature A REVENUE OFFICER 22-06-1418
for JAKOB PEDERSEN (717) 777-9621
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of N tice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X