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m bbd U. S. TREASURY DEPARTUAENT - ~NTER?+~~ REVEr+uE SERViCE F« OPe.o~e1 Use er Reco.d..p O:e ~ ~
iREV.8-67) NOTICE Of FEDERAL TAX LIEN UNDER INTERNAL REYENUE IAwS
~ISTRICT sEa~~~ No. F l ~ E O A ND RECORDEO ~
~ S'. LUC1~ COUNTY, F~A.
Pursuant to the provisions of Sections 6321, 6322, ond 6323 of the Internal Rsve- G~~~ S'FRIFt~p y
nw Code, notice is hereby.given that there hove been ossessed under the Interna) 1~~7 ~
R~venw laws of the United Stotes ogoinst the following-nomed toxpoyer, ~axes p AL ~
(inctudin9 interest and penolties) which ofter demond Fw poyment thersof remoin ~J ' U I1~ ~ 23 ,
unpoid, ond thot by virtue of the above-mentio~ed stotut~s the amount of soid toxes, ~
topeth~r with penoltiss, intsrest, ond costs that mor accrus in oddition th~reto, is JC/~~
o lien in fovor of Iha Uni~ed Stotes upo~ ull property ond rights to property belong• ~~~=E' f01TRt~$ :
~~y to so~d taxPoye?. CLERK CIRCUIT COURT ~
NAME OF TAXPAYER ~
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RESIDENCE
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CLASS OF TAX UNPAID BALANCE ~
(Tox Return Form No.) PERIOD ENDED ASSESSMENT OATE fDENI }F Y fN.i NUMBER OF ASSEjSMENT
(01 (b) ~c ) ld i (e )
~ 1040 i2 31 68 06 ~1 69 496 36 To19 3141.48 ;
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PLACE OF FILtNG
Cl9t'~[~ C~'Cl~t? C01i='f. TOTAL S 3~•'~ '
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WITNESS my hand at 3a~' e~to C~for~nia , on this,. ~
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~ the z3r~d day oF ~etabe_r ,19 (7Q
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~ SIGNATURE TITLE
(NOTE: Ce.r icot~ ol o(fic~r outF+arised br law to tok~ ockno.l~dym~MS is not ~ss~ntiol to tM yel~d~rr of Notic~ of F~d~rol Tac Li~n G.CJ~A.
26119. C.B. 195P51, 125.)
~ 90~K 181 PACE
- PART 1 To b~ retain~d by recording office
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