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~a" U. S. TREASURY DEPARTMENT - INTERMAI REVENUE SERVICE Fw Op~w~f Us~ Ap Reca~liy Okict
caEV. a.a» NOTICE OF FEOERAI TAX Lipl UNDER INTERNAt RE1fENUE LAw D ANO RECQROEO
DISTRICT SERIAL NO. ST. UCIE COUNTY. FLA.
Jacksonville i ~ COR~ ~~~RtFJ[:0['
Pursuont to th~ provisioos of S~ctions 6321, 6322, ond 6323 of th~ Int~rnol R~v~- ,1~~J .
nw Cod~, notic~ is Mr~br ~iv~n thot th~r~ har~ bNn ass~ss~d und~r th~ In»mol
R~v~nw laws of t!N Unit~d Stat~s oyainst eh~ followin9-no~d toxpoy~r, t~ S Q 6 W'1
(ineludin~ in»r~st and p~nolti~s) which oft~r d~wond fot poy~nt th~r~of r~aain
unpoid, oed thot by virtw of th~ obov~-nwntioe~d stotut~s the anrovnf of soid toxes,
toyether with p~nolti~s, int~~~st~ ond costs thot nwy occrw in oddition th~t~to, is OGER POITRAS
a li~n in iavw of tM Unit~d Stotss upon oll prop~np ond riyhts to ~.oP.~~ b.i«~9~LE K CIRCUIT COURT
in9 to w~d ro,~Por... -
NAME OF TAXPAYER •
~l.l~e 8111'1C6
RESIDENCE
ttt. 3, ~ 3~ ~
Fort Pierce ~ Florida
CLASS OF TAX UNPAIO BAUINCE
(Tox R~turn Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER . OF ASSESSMENT
i ~a) (b) (c) (d ) (e)
; 1040 12-31-67 05-03-~ 2G?+-22-9559 351.04
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PLACE OF FILING CI~'.RK~ CIACUIT OOLRT
$T. LU~IB COUNTY TOTA~ S 35~.01+
FT. P~, FL~tIDt
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wITNESS ~ny hand m Miami, FL~rida , on this,. ?
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