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' Fk~~ U. S. TREASURY DEPARTMENT - INtERN~~ REVEnuE SER i~Cl~ ' Fa Cp~aw~! {Is~ dr R«ad.y OH+c~
~REv, &67? NOTitE 0~ ~EDERAI TAX liE1! UIlDEt INTERNAL ~EilEN1~~ LAwS
DISTRICT SE~t1AL NO. FII.~O AND R~C~ p_RDgD~
JaaksoavilL _ T. LUCIL C~tINT~Y. F'4A. ~
Pwsvont to tM p~c+visions of Ssctions 6321, 63n;,ond 6323 of the inter~! R~v~• RECORD V~RIR~ED
nu~ Co~e, notic~ is h~r~bv yiv~n thattl~~r~ hove ~tln ossess~d under ths Iotarnol
R~v~nu~ lows of the Unit~d Stot~s oyoinst th~ (Ollowinp-named toxport~, toxes
(ineludleq int~r~st and p~nalti~s) which oh~? d~Aqnd for payenent th~reof r~moin~?e u. y
unpoid,'ond that br v~~~w of th~ obov~-m~etion~d statuhs th~ omount of soid taxes, a7 Nil ~ ~ 3~ S~ ~
toy~th~. with p~nahi~s, int~nst~ and costs that nq~ accrw in oddition tMnto, is ~ ~
o li ~n in fov w o f / M Uni t~ d S f
o t~ s v p o n o l l p r o p ~r tr a n d ri9 h ts to p r o p tr ty b~ lony _ ~
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~n9 ~o said toxpoyer. fl0(3~R POITRA
NAME OF ~AXPAYER RK CIRCUIT COURT~
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RESIGENCE
15~1 L~u~w 0 ' . _ ~
Fort Pi~ros, l~lorida
CLASS OF TAX _ UNPA10 BALANCE
(Tox R~turn Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~01 ~b) ~c ~ ~d ) ~e)
lalto 12-31r-65 4-8-G6 265-51~6158 ;396.32 ~
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PLACE OF FIIING Ci~"Cti~t '
~ $t,~ j,yQ~ Cip~tlp~ TOTAL i 3~•32 ~
FQ'ti ~~TO~~ ~3+01'~+ai ,
W{TNESS my hand ot ~at $r~• , on this,.
rh.~_do~? of 1~.~ ,19 69
SIGN , TITLE • ~
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MOTE: C~rHfte~ ~f eiliew wtMripl tir I~ fe t~k~ ~ekn~.l~Mn~s is we1 ~s~~~iol t~ t!~ +~lid;e~ d NMta ~1 F~~1 1~s liew C.CJI.
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~ART 1 Te M ntoin~d b~? ntordln~ elfit~ . ~~~~rU 1
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