Proof of Claim for

Internal Revenue Taxes

Department of the Treasury/Internal Revenue Service

Form 10
Attachment
Case Number
12-11780-CSS
In the Matter of: TERMINAL SERVICES LLC
2302 P ARKLAKE DRIVE
SUITE400
DECATUR, GA 30345
Type of Bankruptcy Case
CHAPTER 11
Amendment No. 1 to Proof of Claim dated 06/20/2012.
Date of Petition
06/10/2012
The United States has not identified a right of setoff or counterclaim. However, this determination is based on available data and is not
intended to waive any right to setoff against this claim debts owed to this debtor by this or any other federal agency. All rights of setoff
are preserved and will be asserted to the extent lawful.
This Claim Is Being Withdrawn.
Unsecured Priority Claims under section 507(a)(8) of the Bankruptcy Code
Taxpayer
IDNumber
KindofTax Tax Period Date Tax Assessed
Tax Due
XX-XXX7582 WT-FICA 06/30/2011 NOT FILED $800.00
XX-XXX7582 WT-FICA 09/30/2011 NOT FILED $800.00
XX-XXX7582 WT-FICA I2/3I/20I I NOT FILED $800.00
XX-XXX7582 FUTA I2/3I/20I I 2 Unassessed-No Return $56.00
XX-XXX7582 WT-FICA 03/31120I2 NOT FILED $800.00
XX-XXX7582 WT-FICA 06/30/20I2 NOT FILED $800.00
$4,056.00
Total Amount of Unsecured Priority Claims:
I THE ABOVE UAAJUTY HAS BEEN LISTED AS A POTENTIAL LIABILTITY FOR THE DEBTOR BECAUSE THE RETURN HAS NOT BEEHF\l.ED. AS SOON AS TilE DEBTOR FILES TIIERETURNWJTH TliF.IRS AS RE-
QUIRED BY LAW THJS('J.ALMV.'lLL BE ADJUSTED TO REFLECT THE ASSESSED LIABIUTY
2 UNASSFSSED TAX UABIUTY(IES) HAVE BEEN LISTED ON THIS CLAIM BECAUSE OUR RECORDS SHOW NO RETURN(S) FILED. WHEN THE DEBTOR(S) FILFS THE RFTIJRN OR PROVIDES OTHER INFORMATION
Page I of I
Interest to
Petition Date
$0.00
$0.00
$0.00
$0.6I
$0.00
$0.00
$0.6I
UNITED STATES BANKRUPTCY COURT---------DISTRICT OF DELAWARE
COURT USE ONLY
Check this box if this claim amends a
previously filed claim.
number: 1-800-973-0424 email: Creditor Number:
Court Claim Number:
(If known)
Filed on: 06/20/2012
7
Name and address where payments should be sent (if different from above):
Internal Revenue Service
31 HOPKINS PLAZA, RM 1150
BAlTIMORE, MD 21201
0 Check this box if you are aware that
anyone else has filed a proof of claim
relating to this claim. Attach copy of
statement giving particulars.
Telephone Number: (410) 962-4585 email:
Amount of Claim as of Date Case Filed: $4 056.61
If all or part of the claim is secured, complete item 4.
!fall or part of the claim is entitled to priority, complete item 5.
0 Check this box if you are the debtor
or trustee in this case.
Check this box if claim includes interest or other charges in addition to the principal amount of claim. Attach a statement that itemizes interest or charges.
2. Basis for Claim: _____
(See instruction #2)
3. Last four digits of any number by
which creditor identifies debtor:
Secured Claim (See instruction #4)
3a. Debtor may have scheduled account
as:
Check the appropriate box if the claim is secured by a lien on property or a right of
setoff, attach required redacted documents, and provide the requested information.
3b, Uniform Claim Identifier (optional):
Amount of arrearage and other charges. as of the time case fded,
included in secured claim, if any:
$c._ _____ _
Nature of property or right of setoff:
D Real Estate 0 Motor Vehicle [J Other Basis for perfection:-----------------
Describe:
Value of Property:$. ______ _ Amount of Secured Claim: Sc_ ________ _
0 fixed or n variable
Amount Unsecured:
$ ______ _
Amount of Claim Entitled to Priority under II U,S,C. 507(a). If any part of the claim falls into one ofthe following categories, check the box specifying
the priority and state the amount.
Domestic suppot1 obligations under
II U.S.C. 507(a)(l )(A) or (a)(! )(B).
Up to $2,600* of deposits toward
purchase, lease, or rental of property
or services for personal, family, or
household use- 11 U.S.C. 507
(a)(7).
r-1 Wages, salaries, or commissions (up
to $i 1,725*) earned within 180 days
before the case was filed or the debtor's
business ceased, whichever is earlier-
IIU.S.C. 507 (a)(4).
Taxes or penalties owed to
governmental units- II U.S.C. 507
(a)(8).
C Contributions to an employee benefit
plan -II U.S.C. 507 (a)(5).
Amount entitled to priority:
$4 056.61
J Other- Specify upplicable paragraph
of II U.S.C. 507 (a)LJ,
*Amounts are subject to atQustment on 4/1113 and every 3 years thereafter with respect to cases commenced on or after the date of adjustment.
Credits. The amount of all payments on this claim has been credited for the purpose of claim. (See instruction #6)
310 (Official Form 10) (12/11)
7. Documents: Attach are redacted copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized
statements of running accounts, contracts, judgments, mortgages. and security agreements.lfthe claim is secured, box 4 has been completed, and redacted copies of
documents providing evidence of perfection of a security interest are attached. (See instruction #7, and the definition of "redacted".)
DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING.
If the documents are not available, please explain:
8. Signature: (See instruction #8)
Check the appropriate box.
I am the creditor. U I am the creditor's authorized agent.
(Attach copy of power of attorney, if any.)
IJ I am the trustee ofthe debtor.
(See Bankruptcy Rule 3004.)
D I am a guarantor, surety, indorsor, or other codebtor.
(See Bankruptcy Rule 3005.)
I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my knowledge, and reasonable belief.
Print name:
Title:
Company:
C. PETRY
Bankruptcy Specialist
Internal Revenue Service
Address and telephone number (if different from notice address above):
Internal Revenue Service
31 HOPKINS PLAZA, RM 1150
BALTIMORE, MD 21201
Telephone number: (410) 962-4585 Email:
_ls!_C, rETRY
(Signature)
. __
(Date)
Penalty for presenttngfraudulent clatm: Fme of up to $500,000 ortmpnsonment for up to 5 years, or both. 18 U.S.C. 152 and 3571.