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F~ ~ U. S. TREASURY DEPARTMENT - INTERNAL REVENUE SERVKE F~. O~r.MI'tlw 8r R~cal+! O~~ c~
(REV.B-67) MOTfCE OF fE~ERAI TAX l~N UMDER INTE~NAL REIIENUE IAwS
DISTRICT SERIAL NO. ~ICEO,AND'R ~ '
J ~UCI~ ~0
Pu?suant to tl~ p?ovisions oi S~ctions 6321, 63 ~ ond 6323 of tM loterrwl R~v~- RECORb VERIFIEp
nw Cod~, notic~ is Mr~by 9iven tFat th~r~ hove bNe ass~ss~d under th~ Int~rnal
R~v~nw bws of tM U~it~d Stot~s opainst th~ followin9-nomed ta:poy~r, to:~s 191545
(iecludin~ int~r~st ond p~nolti~s) which oft~~ d~wona for poymeet ther~of r~main 1~ .
uopoi~, oad thot by virtw of the obov~•m~ntion~d stotut~s tM omouot of soid toxes. ~
toy~tlNt with p~nalties, i~f~t~st, ond eosts that nqy oeerw in odditioe~ tl+~r~to, is ~ /
1a~W i
a litn in iovw of th~ Unit~d States upa+ oll property ond rights to prope?ty Mlony- ~
in9 to soid toxpoy~~. . ROG~ ITRAS
NAME OF .TAXPAYER ~RK CIRCUIT CO{i~
J.B. BIAC~1li
RESIDENCE
$tr~ 3, B0~ ~a~ ~Ol~ ~~~i~ ~+OTi+air~~~ .
CLASS OF TAX UNPAID BALANCE
(Tax R~tv~n Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSIAENT
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l~otao i2-33~b7 ]o-zL-b9 256-20-9759 ~3•3v
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~ WITNESS my hand at ~ ~~t? PiL B~iCh~ F1+0~'Lds on this,.
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~ the_2111~L_day of 1'4~ ,19 ~
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~ MOTE: Ger~ifieoH ef of(ic~r ourMri:~d ~y low ~o tak~ xknowl•dyw.ma is not ~ssenlio) to th~ volidit~r of NMic~ d F~d«~1 Teu I.i~n G,C.M.
~ 26419, C.B. 195d51, 125.)
~ PART 1 To b~ ntain~d by ncordin~ offic~
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