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~ U. S. TRE/WJRY ~EPARTMENT • INTQRNAL REVENUE SERYICE Fa ~wFl1~ ~~t~co.l+rONic+
(REV. ~.sn NOTICE Oi FEOERAL TAX lipl UMpER INTERNAI RErENUE IAwS ~~„Ep pN0 R.¢CORO D~
DISTRICT SERIAl. Nb. ` S. ~.UCIE COuNTY.
~ RFCORD VkR1~lE0
Pwsvont to tM p~ovisions oi S~ctions 6321, 6322, aad 63Z3 oF tM Int~ma R~v~• ' l~~s
nue Cod~, notie~ i: h~r~by yiv~n thot thon Mv~ bNn oss~ss~d und~r th~ lo»rnol tQ
R~v~nw lows of tl» Unit~d Sta»s aqoinst tM followinq-nan~d toxpor~r, tax~~e OCT i v
(ineludin~ iot~~~st ond p~nolti~s) which oft~r d~~ond for poraant th~no( r~moin
vnpaid, and that by viHw of th~ above-m~ntion~d stotut~s th~ omount oi said tox~s,
to~thK with p~nolti~s, int~nst~ and costs that nwy aecrw in addition tMr~te, is R4GER POITRAS
o li~n in fovo~ of tht Unit~d Stot~s upon all prop~rty ond ri~hts to prop~rty b~lonq- ~ aK C~RCV~7 C~UR~:
in~ to said taxpor~?. ' -
NAME OF TAXPAYER "
RESIDENCE • - ,
Sunri Bl~d. Fort Pieres Fla
Cl.ASS OF TAX ' UNPAID BALANCE
(Tpx R~turn Fonn Nof) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~a1 tb~ ~cI ~d~ ~ -
1W;o 12-31-67 ~5-?1.-68 4.t5-?J.-1421 6,51~?.34
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PLACE OF FILIN6
CI.I~tK~ CIIaC~T C~UI~ TOTAL s 6,SL?.3~
SJIIIR I~lCIB COUIf'1'Y~ FT PTS~C6, Fi.A.
WITNESS mr hand a . oe this,.
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tht_.1~.__do~? oi Oet. ,19 b$
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IGNATUR TI LE •
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` E: G.t~he~ J~i1te~. wtiwls~l ?p Iw h a1n ~ckn~wl~~nrs is ~si«Mid +A~ •~I~iryr ~f N~t~e~ d f~l To 4t~w a.CJi1.
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rARt t-T. r.:s1.i~.d Mr neo~s .Niw . .