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F~ofm QdR U. TREASURY D~P/VC~~~ . ~NTER~~ REVfNUE 5ERVICE I Fx OpiaqF Ib~ i~ R~cordinp OMks
(REV. 4-65) NOTICE df ~EDERAL TAX WE]ri tNiliER INTERMtAL REYENUE UVYS
DtSTRICT • 59tl~L NUMBER 13~512
__..___.Ia~k,Snn~~i l l,gi Fl orid
Pursuant to fhe provisions of Sections 6321, 6322, afld 83Z3 of tho Internal Reven~e Code, +
notice is here6y given that there hove been oaseu~d under the Internal Revenue laws of the ~ j7 ~1
United 5tates agains! the fotlowing-named fa~cpayeM, tvxp (Indudfng inte~est and penalr~es? which 4 t r"
after demand for paymenf thereof remain unpCid, ond tF1af by virf~e of tha obove•mentior,ed m ~
statutes the omount of said texes, toyether witl~ pertoltlea, Irltetett, and costs that may accrue m ~ ~
in addition thereto, is a i~en :n fcvor of the United $toTea u~fpn e~~ pnpperty and rghts to property C-s~ •A
be!onging to said taxpayer. r- ~ C ~ v
_
NAMc CF TA3CPAYER ~
Rohert E. Hatfiel~:., Jr. ~^ar A. 6laller~ ~'~i=~ rn
0'{ T~.T'g S±nrA D~ Cn ~ C7
~ESlDENCE OR PLACE OF BUSINESS - Z n ~
] R~t; Orande Ave., m ~ 4
~'ort Pi~rce, ~'lori~a ~ c.`'n o O ;
CLASS OF TAX X '
( UNPAID BAIANCE
(Tax Retum f-ortn No.? PE~IOD ENDED q$$~MB~IT pq7E ~ ID:NTIFYING MUMBER pF A$SEj$AAEN7' ~
~O~ ~b1 (~1 (dl lel
9~1 9-30-63 ?-1~..55 59-].0081~1~7 233.65
9~~. t2-31-63 7-1~-h5 5~-loo8~fi 281.96
9~:1 3-31-hi~ 7-16-55 ~9..ioo84+a? 338.01
91~1 6-?c••~ 7-x6-~5 K9-loo8t~t~7 231;.75
9~.1 9-34-5It 7-16-65 59-1.~o~'ili.l~7 18~.00
91~1 7.2-31-5l~ 7-15-hK 59-1[~~l.~l;7 185.82
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Piac~ c~ F~u?~c rlerk~ C~ rcuit Co~~?^t
~ 5t. I~~~ci.e Countv, ror~ s 1 l~62.20
~ t., ~erce: F'2o *ri da s
wiTN~S my hand at S~Test PaL~n 3each, Flor~i.da on this, .
the_ 11 t}, day af nctnbe , 19
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Di5TRICT DIRE{,'~pR pF IlVS'EW+l,ql REVENUE ~r (Si~ppit~) TITIt
F'•S. SC~lT~~C~t {'rI~(itt~f $Li~BI'V~.~(?3'
tNOTE: Certifimte of cfFicsr ovtfioriz~d by law to ~ke od~r~ow?rdytneras is naP rsserMia) ro ths volidFty d NWlo~ of Fsd~rol Tax Li~r~ G.C.AA.
26119. C.S. 1950-51, 125.)
PAItT 1-To b~ r~ned br raconlin9 affia p~ ~'~Q -
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