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Fenw 668 U. S. TREASl1RY ~EPARTMENT • 1NTERNAI REVEHUE SERVICE Fa Opr~ Uu Br Recad~wq O/l~ce
(REV.B-67) NOTICE OF FEDERAL TAX LIEN UNDER INTERNAt REYENUE LAWS
DISTRICT sERiA~ No. FILED AND RECOROEO`
ST, LUCIE COUNTY. FLA.
RFCQR~' VERIFiEO
Pu~suont to the provisions o( SeNions 6321, 6322, ond 6323 of the Internol Reve-
nue Code, notice is h~reby given thot there hovs 6een assessed under the Internol ~ ~
Rsvenue laws of th~ United Sto~ss oyoinst ths following-nomed taxpayer, taxes Q 58
(inclvding inte~sst ond penolties) whieh ofte~ d~mnnd lor payment thereof remoin t0 APR I J • ~
unpoid, ond that by virtue of the obove-mentioned stotut~s the omount o( said toxes, ~G~
to9eth~r with penolties, i~terest, ond costs thot nay accrue in addition thereto, is
o lien in fovw of the United Stotes upoo oll prope?ty ond riyhts to propeHy belony- i~~,.i~t; ~'QIZR%+`J
~~e to :a~d fax~r... CLERK CIRCUIT COURT
NAME OF TAXPAYER
,
~idl rri
RESIDENCE
707 C~illingsvorth Drive ~
CLA55 OF TAX UNPAID BALANCE
(Tax R~tur~ Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) ~b ) (c 1 (d ) (e )
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r 941 Nit6holding 03-31-69 02-06-70 59•1230091 $ 10,07~.67
f .
~ 941 iiit6holding 06-30-69 02•05-70 59-1230091 3,713.98
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~ PLACE OF FIIING
~ Clerk, cir~ait court TOTAL s 13,788.65
~ St. Lncia Count~ :
~ ~ort Pierce, Florida
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~ WITNESS my hand dt West Pala~ Beach, lrlorida , on this .
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~e lOth dQy o{ 1~ ~q 70 :
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SIGNATURE TITI.E
~ ' aCtING I~
a;. ~ GSOUP 8UP'B1N ~
~ (NOTE: C ~iico:• of otf~cer o~~nori:~d by law ~o tok~ acknowl~dqmenis is not ~ssentiol to t.Nvolidiry of NWice of Federol To= Lien G.C.M.
26419 .8. 195051, 125.)
~ eooK 183 ~cE i~97:~
;~:f PART 1-To be retained by recording office
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