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U. i. TR~ASURY DEPARTMriNT INTtRNAL REVENUt flRViCt
- I~OTI E OF LEVY
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CLEaK CIaCU1T COURT' DATt
You aro hereby notified that thera is now due, owing and unpaid to the U~itad States of America from the taxpayer
whoss name sppesn below the sum of ~ 1~•~
TAX FORM OATE Of UNPA10 sTATUTORY
~ PERtOD ENDED IDENTIFYING NO. SAIANCE OF TOTAL
Np, ASSEt3MENT A4SESSMENT AODITIONS .
91~1 12-31-67 3-29-68 59-~s74655 s 182.4o s 13.5b s 195•96
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TOTAL AMOUNT DUE s 195.96 '
You are further notified that demand has beer? made upon the taxpayer for the amount set forth herein, and thai wdt
amount is still due, owing, and unpaid from this tanpayer, and thst the lien provided for by Section 6321, Intemsl Reve~
nue Code of 1954, now exists upon all property o? ri~hts to prope?ty bebnging to ths aforosaid tsxpsyer. Aooordin~iy,
you are further notified that al) property, rights to property, moneys, uedits, and bank deposits now in your posses:ion
and belonging to this taxpayer (or with rospect to whicfi you am oblisated) and all w~ of money or other obligations
oge
owin~ from you to this taxpayer am here levied vpon and seized for satisfection of the afore=eid tax, together with
all additions provided by law, and deman is hereby made upon you for the amount neoessary to satisfy the liabilit~l
set forth herein, or for wd~ lesser sum as you may be indebtsd to him, to bs applied as a payment on his tax liability.
G'hscks or money orders should be made psysbk to "intemel Revenue Servioe".
i1GNA URE ' TITLE ADORElS (CITY ANO iTATltI
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f . PART 1- TO BE RETURNEO TO INTERNAL REVENUE SERVlCE }