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Frn~ 66~ U. S. TREASURY O~ARTMENf . INfERNAL REVEMIE SERVICE f~r GM+Iw~ 11» y bc~dLy dfJw
~R~v. ..as~ NOiN:E Of fEDERAL TAX UEN UNDER INiERNAL REIIENUE LAWS ~p Ap0 RECOR~
DISTRICT $Eq~~ ~
J~~~ . ' gT~RECORO VERIF~IE~ ~
Pvrwo~ ro th~ pravlsions of S~ctiom 6321, 6322, aed 6323 of ths IMKnaI Revemis C~od~ ~
noMe is hsnby ~iven 11wt thsrs Fww bsa~ oss~sssd undsr the IntKnol Rrvsnus {awa of tl:e
Uoitsd Sfct~s oga[nst fh! following-eoe~sd taxpaY'sr, loxes (indt~diA~ ini~ntf ord penalrie~] whldi t~ ~
oftsr da~and for poymsr~t thsrwf ranain unpoid. a~d fhof by vtrhrs of dn above•rt~tioned ~
iranms ~he omoix~t of satci ruxss, age?F~x wt~h pe~wirtas, teM.rssr. and aoats shar moy accn» -
«ia~no~„~.«o, b a lisn in favot of fhs Unifed Stotes upa~ all propKty and riphts to propsrtp RpGER ~'OITRAS
~`~°"°~°°'°'°~'°"~°Y°`' CLERK CIRCUIT COURT
NAME Of TAXPAYHt
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RESID~E~IC•E OR PlAC.F Of e1151NE5S '
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~ ~ T~ UNPAID BALMICE p
(fax Retvm form Na) P9t10D BJDED f~S5E,S5~lABJ! QAiE IDBQiiF1fING NUMBER OF ASSES5M9dT
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941 12-31-67 3-21~•67 59•1090321 ~ #72~a.41
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PIAGE OF RLING (~i~Z't~ ri~~li~.tr Ci0i0~''tr ~
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Fort Pi~rce~ Flo'r3~d+a ~
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WITNESS my hand at _ l~feat Pili B~aoh, F3+0l1dt ~ on tfiia, '
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the lOtb of ~ortl -19 b7 ~
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o~sra~cr a~c.~of ~Nr~ ~ve~~ ~ ;
l. J. O~Doat~ll, Jr. t6a~as C r s~~~0°~
IN076 GrNfioo~ d dAa? a~Mbori~d by low fo talu ~t ls naf ~iol to th~ vdiditp of Naia of l~d~rol Tmc l»n G~C.A~ ;
Z6~ i 9, C.0. 1930-5 i, 1Z5.) 0 R 165 ~
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