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po~ ~g U. S. TREASURY ~EPARTMENT - iNTERNAt R~vENUE SiRVICE Fa Op~a~el Use 8r R«ad.p ON~c•
(REV. &67)
I DISTRICT seRi~~ No. F~~EO AND RECORDED
J~~e~t~i13+~ ?~T3~ T. LUCIE COUNTY. F~A.
! Pursuant to the provisions ot S~ctions 6321, 6342, ond 6323 of th~ (nterno) Rev~- r'.C~~Q~
Q~'I(F~~'~'Er
~ue Cod~, notic~ is h~rtby given that th~r~ hove b~en oss~ss~d und~r th~ Int~rnol ~,00~-/J~
Rsvenw laws of thf United Stot~s oyoinst th~ iollowiny-namtd toxpar~r, tox~s 0 ~
(includinp in~~rest ond p~nolti~s) which oft~r d~awnd Eo~ poyment ther~of remoio t~ JA~ r r
' unpaid, and thot by virtw of th~ obov~-m~ntioaed stotut~s t6~ omount o( soid to:~s, ~
. C
i to~th~t with p~~olti~s, in~er~st, ond costs thot nwy accrw in odditioei tMr~to is
~ ~ ' i !!_>s..1 i n and i !t! ~
~ ~~a: ....s.~.. s~s a!! ~_~riy r $ a te crone:tg ~lea:eg- . ~ ; ^nt7R~S
~ iny to soid toxpor~r. ,:!)!~._r +
c~~aK ciRCUiT couRT ~
NAME OF TAXPAVER ~
~T~ ~
RESIDENCE
31~ 1~~~ R~~ Tt~ r11l+~i ~l+~ars~ii.~3~
,
CLA55 OF TAX UNPA10 BALANCE
(Taz Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) (b) <<) (d 1
i
~ 9f~i 9-~-69 s~t.aeb-69 59~0905~ d~T.t= :
~ ~
;
~ ~
~
~
~ PLACE OF FILING Cs~' ~t C~s
~ ~ j~ C~~ = TOTAL S
~ ~1
~
WITNESS my hand ot ~ ~"s~~
the_~_doy of ~~~~_,19
SIGNATU TITLE
~
:~rtifi c 1~.+ ~o tala xknewl~dps~n~a is n~t ~~s~ntiol te tM volidiry d Notic~ ef F~al Tu l.i~n G.CJA.
T°~ ~6419, C.B. 195a51, 125.)
d~lf~~~, ~;iGE~~~t~ ~
~ PART Z
To b~ rtc~ipted and retum~d to ta~ Int~mal R~v~nw SKV a
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_ e~e~ ~ . . __r.