HomeMy WebLinkAbout11-1028Form 668 MW
(Rev. February 2004)
11883
Department of the Treasury - Internal Revenue Service
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 744306111
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, --n
there is a lien in favor of the United States on all property and rights to 3 --t
property belonging to this taxpayer for the amount of these taxes, and r"W rn-':'.
additional penalties, interest, and costs that may accrue. =; a
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Name of Taxpayer JAM DINER INC, a Corporation '
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YORK RD FAMILY RESTAURANT
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Residence
160 YORK RD C) - C
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CARLISLE, PA 17013-3149 c-n
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, ?? QU
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on the day following such date, operate as a certificate of release as defined ?
in IRC 6325(a). 1? as4L tf??
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)
941 03/31/2010 27-1557515 09/27/2010 10/27/2020 4185.64
941 06/30/2010 27-1557515 09/20/2010 1.0/20/2020 5821.14
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 10006.78
This notice was prepared and signed at
the 19th day of January
DETROIT, MI
2011
, on this,
Signature Title
_ REVENUE OFFICER 22-06-1413
for LINDSEY O BOWLIN =4-46j (717) 777-9623
(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 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X