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Fpnn bba U. S. TREASl1RY DEPARTMENT • iNTERNAI, REVENtlf SERYICE- ~ Fa OW.onolUu By Rcco~d.~y CN~ce
,aev. s-s~, iiOTitE OF ffDEitAI T~X li~li UiiDEit iiiTfilN~i itFYEiiUf tAYU3 -
DISTRICT SERIAI NO. F~1-EO ANQ RECORDED
Jackeomille~ Florida ST• ~ F C t~ R ~ V F R i FYE pLA.
Pursuont to t!~e provisions oi Sections 6321, 632?~ ond 6323 of thw In+crnol Revs- ~
nue Cods, ~otict is Mreby give~ thot there hovt b~en oss~ssed under the (nternol
R~v:nw luws oi the United Statas ogoinst th~ foltowioy-nomed toxpay~r~ tox~s ~ ~ pN ~ s OS ~
(i~clud'eo9 int~rest ond_ penoltiss) which aftet~ d~wond. (u poyment thereof re~+oin ~~~~.y ~
unpoid,"ond tlwt br virtu~ o( the.above-mentiomd stotut~s ~R~ amount of said toxes, ~ ~
togeth~r, with penoltiss, i?~terost, ond costs tho~ nio~ otcrue in oddi~7on thersto, is , , ~
o li~n in fovor oi f}?e Unit~d Stotes upa+ oll pfop~~i ond ri9hts to propertr belonp- 't0`J'"R QO'~R~$
~~9 ro so~d roX~y... CLERK CIRCUIT COllRT ~
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NAME OF TAXPAYER • . s
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~1i0AN & HOBBY B~ARHI~ .
R'c51DENCE ~
~1~4 ~vern~e MO"~ Fort Plercei Flori~d,a~-33450 .
CLASS OF TAX - UNPA10 BALANCE ~
(Tox Rsturn Fwm No.) PERIOD ENDED ASSESSMENT OA?E IdENTtFY1NG NUMBER Of ASSESSMENT
(a ) (b) (c ) (d 1 (e)
l0l~0- 12-31-.68 5-3~9 263-1~1.~-1250 473•15
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~ PLACE OF FIIING
$t• I.1bC~.A ~'iO11i1t;~T TO~AL i ~73~~
l~t• ~@TC@~ F3A1`~d8
WITNESS my hand ot " i~i68~ ~stls BABQh~ Fl~OT1+da , on tF~is,.
fhs 28th day of Oatob~r ,~19~ ~ ~
SIGNATUR ~ TITIE
(}~Otip :3qP9rt/~s02' . -
'lho~aa C. ara~ns ' "
MOTE: G~~a~ser. er oHtc« .~,~ho?i:.d br lo. ~o ~ok• ock~+..1.d9w~nts ia net ~is~Mi~l te Nw veliditp d Ndle~ ~F F~el T~c Li~n G.C~1.
se • _
~i9, c.B. ~ssas~. ~ts.) ~f~~
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~ART 1 To b~ ntain~d br r~condin~ ofHc~
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