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Fom+ 668 U. S. TREASURY D'rPARTME~lT _ INTERNAL REVENUE SERViCE I` Fa ovn~r w. !r R.cwdlry OHJer ~
(REV. 4•d51 NOTlCE OF~ FEDERAI TAX LIEN IdND~R INl'ERNSL REYENUE UIWS
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bISTRICi I SERiAI NUMBER
1
Jacksonl?~ lle, Florida
P~rsuant to the provisions of Sect~ons 6321, 6322, and G323 of the Intemal Reven~e Cede,
no!i:e is heraby given thot rhere hove been assassed under :he Ir.ternal Reven~~e laws of the ~j
lir~'ted States egoinst the foilowing-nomed taxpoyer, toxea (incfuding interest arn~ penalties) which ~ ~ ~1
oiter demand for payment thereof remoin unpoid, and that by virtue of tha o6ove~mentioned t 1"'
ste+.~t~s ihe amount of sa~d taxes, together wi!h penaities, interest, and cos?s tFa! moy accrue ~ r' ~ ~
ir c.:~J Hon thereto, is a lier, in icvor of ti~.e United States upon ail property ar,d r'gnts to property r~~
be'ongirg to so:d taxpayer. ~ ~ ~
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NA 1Ae OF TAJCPAYER - - O fTi - W~ I
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Ch~rles R• ~llen H,. Robertsc~n D c~`'
P.ESIDENCE OR PLl~C'c OP BU51NES5 ~.C.
1Q29 T~^inidad Ave., ~'t. t'~.erce~ ~'l.a. ;C~ ~
CLASS OF TAX ~ i I UNP ID CE
(7ax Ret~m Form No.~ PERIOD ENDED ASSESSAAENT DATE ~ IDENTIF~ING t~tUM6ER OF ASSESSMEM
lal Ibl (~l I Idl Iel
iot;o ~.2_?i_64 5-19-~5 ?E,?-o5-0093 x, 03~..58
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~ ~ii~~ Clerk~ rircuit Caurt
~ at. :,ucie Ccunt,y rors~ s 1,~3~•58
Ft. Pierce~ ~'lorid,a
WfTNESS my hand at '~l~st Palm ~!ea~h, Fl,oric~a ~y on tfiis,
the day of C~etaber , ~q_~
DISTRtCT DiRKTOR OF IMERIVAL REVL'~lUE 8Y (Si r~sJ . 71TLE
F. S, Schmidt Grnup 9upexwrisar
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• fNOTE: Grtifico+e of nfficsr authorizsd by low to rok~ adcnowtodprt~ns is nof ~~al ro tM wiidi +af NaPU of i~?ol Tax L' G.C.AII
26419, GB. }950•51, 125.~ ~ ~ ~ • n<' ~ ,
, PA~'T 1--Ta b~ ~airad b~r rstardiny etficr ~ ;
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