HomeMy WebLinkAbout1765Fern 66a U. S. TREASURY DEPART6IENT • u+tERwsi. aEvENUE sEtt'/tCE Far O~r.on•IUse Br R~cadry ON,c•
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~RE~ NOTitE Of fEDERAI TAX UEN UNDER iNTEi:NAI tEilEN1iE LAwY E~ AND-ftECQiRDEB---
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Jacksonville, Fli~rida
Purswnt to the provisions of Sections 6321, 6322` and 6323 of the Interrrtl Reve• 1824a~
nw Code, notice is hereby given that there hove btten assessed under the Internal
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taxpayer, foxes
owing-name
toles e9oinst t
e
o
Revenue lows of the United J t
(intludinp interest and penalties) which after dettwnd for payment thereof remain
unpaid,; and that by virtue of the above-mentioned sto_tutes the amount of sold foxes,
topsther with penalties, interest, and costs that mar or:crue in addition thereto, is :; . ~f? t~~lTRi•`S
"tCU1T COURT
o lien in favor of the United Stoles upon all property and rights to property belong- CLERK Clr
in9 to said taxpayer.
PAYER
NAME
OF TAX
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T
j~Oi ~e WYi i, j
RESIQENCE
905 Bluefish Court, Ft. Pierces Florida••33450
GLASS OF TAX UNPAID BALANCE
{Tax Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o) (b) (c) (d) (e )
1O1t0A 12-3168 5-9-69 284-10-3693 1134.21
PLACE OF FILING C , O
3t. Lucie County,
Ft. Pierce, Flee
TOTAL I s 1;31ie21
WITNESS my hand of West Pa7.~s Beach, Florida _ , on this,.
ths~~doy of ,19
SIGNATURE TITLE
S 0. S .Acting group 8uperrisor
MO : Ce-tiflcote ei e(ficer wtherised by law to take ockneNi•dyaents is not essential to tM •slidity of Notice of Federel.Tox Lien G.Ca{.
9, C.B. 195x51, 125.)
PART 1 To be rotoined by ncordin~ office ~~~ ~~~
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