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Fore 66a • U. S. TREASURY DEP/1RTMENT - ~NTEttw~~ REVEr+uE SERViCE Fo. Orr~ons/ Use Br Recwd+q W~~ce
tREV. &67) NOTICE OF FEDERAI TAX LIEN UNDER iNTERNAI REYENUE LAwS `
DISTRICT seRiA~ Na F ~ED AND RECORDED :
g IUCiE COUNT~ . FLA. ~
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Pursuont to the p~ovisions oF $ections 6321, 6322, ond 6323 of the Internol Revs- 1 ~
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nue Codt, notice is hereby given thot there hcve been assessed under the Internol
R~vsnue lows of the Unitad States agoinst the following-nomed toxpayer, tox~s p Q~ 23 ~1
l,including int~rest and penalties) which ofter demond fw payment thereoF remai~169 ~OV '~i ~ v #
unpoid, ond lhot by virtue of the obove•mentioned stotutss the omount of said toxes, ~
to9ethar with penaltias, interest, ond costs that may occrue in oddition tMreto, is
o lien in iovw o( the United States upon oll property and rights to property belon9' ;1(1~~~R ~'0~~~~`5 ~
in9 to soid toxpayer. LERK C~RCU~T COURT ~
NAME OFTAXPAYER F
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a~xi~ w & ~a~sar.a sr~llr,~ ?
RESIDENCE
49~ S~s PRIN,A VISTA ~
FT PI:~.~CE FLA }
CLA$S OF TAX UNPAID BALANCE
FTox Return Form No.) PERIOD EN~ED ASSESSMENT DATE fDENTIFYING NUMBER OF ASSESSMENT
i to ) (b ) (c ) (d ) (e 1
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~ 1 tQ 12-31~8 r23~9 030-12-31~0 5, 652.22
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~ P~ACE OF FIUNG ~
CL~RK CIRCUIT CC~tT `
~ TOTAI s 5,652•22 %
ST I.UCIE: CUU~NTY, FT P~?C~, FLOi~A ;
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~ WITNESS my hand at 1ri~At~?~ FL~JRrl~1 , on this,. :
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~ ~,e th day of FIOVEMBFR ,19 69.
SIGNATURE TITLE
~ C~:~F, GFF3CE GRGt~'
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MOTE: C~rti(icots ot oftic~r ou~Fwris~d by la.. to ~~k~ ockne.+I~dynwMS is not ~ss~ntiol to tFN valid~ry ef NWic~ d F~d~rol Toa li~n G.CJiA.
26I19, C.B. 195451. 125.) 0 R A Q~ ~r~
x;~, ~~OK 10 YAGf r~
~ PART 1 To be retained by rocording oHica
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