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Department of the Treasury - Internal Revenue Service
( Notice of Federal Tax Lien
(Rev. Form Februa 668 ry 2 2004) 0041
Serial Number For Optional Use by Recording Office
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903 811041311
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, c=
there is a lien in favor of the United States on all property and rights to -V :r
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property belonging to this taxpayer for the amount of these taxes, and
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additional penalties, interest, and costs that may accrue. can= '
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Name of Taxpayer THEOS LLC _3> _j
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Residence 3619 SIMPSON FERRY ROAD Try
CAMP HILL, PA 17011-6400 -r 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, ,670 f,?( T
on the day following such date, operate as a certificate of release as defined
RC 6325
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Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) M
940 12/31/2008 71-1029515 06/06/2010 07/06/2020 471.83
940 12/31/2009 71-1029515 06/06/2011 07/06/2021 475.05
941 06/30/2008 71-1029515 02/28/2011 03/30/2021 1563.64
941 03/31/2010 71-1029515 06/06/2011 07/06/2021 10796.86
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total 1 $ 13307.38
This notice was prepared and signed at
the 30th day of August
DETROIT, MI
2011
, on this,
Signature Title
c ` ACS SBSE 22-00-0001
for FRED BANKS (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) Form 668(Y)(c) (Rev. 2-2004)
Part 1 - Kept By Recording Office CAT. NO 60025X