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JI1ROO ~}~ 60 '2'
form 668 U, 5. TREASURY DEPARTMENT, INTERNAl REVENUE SHV'Cf .~...... .', ,"'.-- ___ --..,.
(;lEV, NOV, 1961) NOTICE OF FEDERAL TAX LIEN UNDER INTERNAL 'REVe~LL~~'JlIhiY. rU.
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Dlsr~lcr J.SERIAl N.U.~, eER
-~._------Ja.ck8onvil.l.a., _FJ..a.
Pursuant to the provisions of Sections 6321, 6322, and 6323 of the Internal Revenue Code of 1954,
notice is hereby given that there have been assessed under the Internal Revenue laws of the United States
against the following-named taxpayer, taxes lincluding interest and penalties) which after demand for
poyment thereof remain unpaid, and that by virtue of the above-mentioned statutes the amount of said
taxes, together with penalties, interest, and costs that may accrue in addition thereto, is a lien in favor
of the United States upon all property and rights to property belonging to said taxpayer, to wit:
NAME OF TAXPAYER
__'__n_~ _.n_ John ll.... Kel1.
HSIDENCE OR PLACE OF BUSINESS
121 North 12th
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T
I
Pierce, F1a.
TYPE OF TAX AND PERIOD
(a)
REfERENCE NO,
(c)
AMOUNT OF
ASSESSMENT
(dl
!,SSES5hIENT DATE
lb)
941 9/30/61
941 - 12/31/61
1-11-63
1-11-63
63-1-165210
63-1-165246
211.66
180023
PLACE OF FILING
Clerk, Circuit Court
st. Lucie County
Ft. Pierce, Flao
TOTAL I $
391.89
WITNESS my hand at_
West Palm Beach, Flao
, on this,
the
9th day of
,19~
April
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DISTRICT DIRECTOR OF INTERNAL REVENUE
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.
[
TiTlE
Collection Manager
Laurie Wo Tomlinson
[NOTE, (e.tiFc"'e of officer outho,iled by low to toke acknowledgments i. not essential to the validlly of NotICe of Federal Tox lien G.C.M, 26.19, C.B,
195051,125)
PART 1 - To be retained by recording office