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Farm 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 125202814
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, rI�--
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, andCD
ter '- tv
additional penalties, interest, and costs that may accrue. - �-' -`' -_CD
Name of Taxpayer CHEF EXCLUSIVE LLCCO
,
Residence PO BOX 447 -
BOILING SPRINGS, PA 17007
E
RTANT RELEASE INFORMATION: For each assessment listed below,notice of the lien is refiled by the date given in column (e), this notice shall,day following such date, operate as a certificate of release as defined6325{a}.
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)
940 12/31/2012 26-0554626 06/24/2013 07/24/2023 54 . 98
941 09/30/2012 26-0554626 12/31/2012 01/30/2023 2351. 86
941 12/31/2012 26-0554626 10/21/2013 11/20/2023 4525 .62
941 03/31/2013 26-0554626 07/08/2013 08/07/2023 4407 . 10
941 06/30/2013 26-0554626 10/14/2013 11/13/2023 2715 .26
941 09/30/2013 26-0554626 05/26/2014 06/25/2024 1390 .47
Place of Filing
Prothonotary
Cumberland County Total $ 15445 .29
Carlisle, PA 17013
This notice was prepared and signed at DETROIT, MI , on this,
the 16th day of October 2014
Signature �' Title
REVENUE OFFICER 22-06-2614
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)
Part 1 -Kept By Recording Office Form 668(Y)(c) (Rev. 2-2004)
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