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Department of the Treasury - Internal Revenue Service
Form 668 (2)04) Notice of Federal Tax Lien
(Rev. February 2004)
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 765740411
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,
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.
Name of Taxpayer JAM DINER INC, a Corporation
. YORK RD FAMILY RESTAURANT
Residence 160 YORK RD
CARLISLE, PA 17013-3149
For Optional Use by Recording Ottice
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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, j?. „J
on the day following such date, operate as a certificate of release as defined Q
in IRC 6325(a). F'O-TL-A' ..7 .S/ O}G 7
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d (e) (f)
941 09/30/2010 27-1557515 02/14/2011 03/16/2021 6908.58
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1$ 6908.58
This notice was prepared and signed at
the 15th day of March
DETROIT, MI
2011
, on this,
Signature Title
?/c REVENUE OFFICER 22-06-1413
for LINDSEY O BOWLIN (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