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U. S TRF115URY DEP/11CfMB~1f . MITERNA4 lEVHrUE SERVICE ,s fer (Ar~ b Rw~ OR~
;~v ..~QS~ NOTN~ Of FEDERAL TAX UEN UNDER ttlTEft~W. REYENUE LAWS ST, AN~ REC
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Jackaouville~ Florida % • R~ vERIF1ED~' ~
RxwwM to th~ peo~vlsio~n of S~c~ian 6321, 6324, and 6323 of ths Intanol Rsvsews Cod~,
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IW1iC~ ~i QiVMI 1~101 ~ fhKO ~10W bl0~1 Olf~fi~ Y~IdM 1~M IRhff10~ ~{Y~MM ~OW3 Of t~N ~ ~U . ~
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a 1~ o y oinst th~ followi n g'~oensd t a~ C
y s tax~s (Mdudi n
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e d 51at~s u p o n all p r v p~ r f y and r i phts to p ro p s A y ~~f R
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NAAtiE OF TAXPAYBt -
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Re51DHJCE OR PU1CE OF dllSiNe55 . .
P.o. Boz 83T, Fort Pisrce~ Florlda~-33450
~ C1A55 OF TAX UNPAI~ BAIANCE
(Tax RMvrn Foem Na) PHt10D.B~D~ HSSBSAIIB~(f QAiE IDENTIFYING Nt1la8ER Of ASSESS~MB~Ii t
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941 3-31-67 6-2-6? 59-0515465 3,174.58
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RAiCE OF HllNG~~1'j~~ j,S'Cl]~t. riO1lS'tr
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Fort Pi.~ra~, Flrorida 3s174.58
WITNESS my hand at iieat Pala H~aoh, Fl+orida , on this,
th~ Zih day cf Jn1T ,19 b7 ,
DISTRlCT qR6LTOR dF IMBWAL ~ ~ T~
: >.J. O~Dormell~ Jr~ ~OT
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p~oTEr C~rt{Aoo~. of otNo~. au~hw~a.d b~? bw w wb odcnowNdpnwra k na ~«+rioi a t!r vait~r ~f Naia oi Pid«oi Tax u.n G.Glll .
4dt19. G!r 1950-51. 125.~ ' -
~T. ~ g~ ~67 ~ 554 .
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