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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
(Rev. February 2004) 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 937190413 -L-
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. rn co
Name of Taxpayer PA TOLEDO INC, a Corporation
PLAZA AZTECA MEXICAN RESTUARANT ::0
C
Residence 5125 MONROE ST � � �-�',�
TOLEDO, OH 43623 -3429 � � 7
;';
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 ;2 /•S �P
in IRC 6325(a). 1 oXo
Tax Period Date of Last Da yy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) M
941 12/31/2010 27- 1069667 07/18/2011 08/17/2021
941 12/31/2010 27- 1069667 11/12/2012 12/12/2022 23282.00
941 06/30/2011 27- 1069667 10/03/2011 11/02/2021 8109.34
Place of Filing
Prothonotary
Cumberland County Total $ 31391.34
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 02nd day of May 2013
Signature Title
REVENUE OFFICER 22 -06 -1408
for MIGNA RODRIGUEZ (717) 777 -9622
(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 Form 668(Y)(c) (Rev. 2 - 2004)
CAT. NO 60025X