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Fern~ 668 U. S. TREASl1RY ~EPARTMENT - iNTERnw~ REVEHUE SEav~tE Fo.OM,oN! Use Br Rec«d.o~ ON~c~
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1: DISTR CT 67' sERiA~ No. ILED AND RECORD~~D~
J~~~w , L.UCIE COUNTY. FLA• _
Pursuant to th~ provisions of S~ctio~s 6321, 6322, ond 6323 of the Internol Reve- C'
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nus Cod~, notice is h~reby givsn thot th~r~ hov~ b~~n ossessed undtr the leternol i ;
~ R~venw lows of th~ Unit~d Stot~s upoinst the IOllowiny-oom~d toxpoyer, toxes pV q ( O s
(includinq int~t~st ond psnolties) which oft~t d~aand (or poyment thereo( ?emoin ~70 ~AN ~ '
uepoid, ond thot by virtw of th~ obove•m~ntion~d stotutes the omount of soid toxss, S
to~th~r with p~nolti~s, inttnst, ond costs that moy atcrw in addition tMreto, is t i
o litn in farw of fhe Unit~d Stot~s upon oll ptop~rty ano ri9nts ~o prop~rty oeiw~y- ~UV;~ rVi i n?':.~,+ '
inq to said taxPoyer. LERK CIRCUIT COURT~ ~
NAME OF TAXPAYER ~
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RESIDENGE
l~oati 1, D~o~ eTly lt.. Tl~~ !'l+~ari+i~ - 331~50
CLASS OF TAX UNPAID BALANCE ~
i (Tax Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
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~ , 1~0 32•~L•~6d T•11~6~! ~lr-~4-~ 1s543•93 :
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P~ACE OF FILING a~it ~y~
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- WITNESS my hand at ~ ~"s~•
th~~t~dey of .i~aomt ,19 7~
SIGNATU TITIE
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OTE: C d br lan to tak• «knewl.d~w.MS is rat ~as~~i~l te tM •olidlry e( Neric~ d FeJ~~I Te: LIM G.CJiI.
` 26119. C.B. 19So-51. 115.)
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To bt nt~ipt~d and rotumed to th~ Int~rnal R~v~nu~ S~rvice
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