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Fore~ 668 U. S. TREASURY DEPARTIiAENT - iHTERN~~ REvEnuE SEttviCE w qpe.oeel Use Ar Rec«d~.g d-•
;aev. e-b» NOTICE OF FEDERAL TAX LIEN UNDER INTERNAt REYENUE LAwS ~ F~~ED AND RECORO~D'
DISTRICT SERIAL N0.
Jaska~n~ill~ Fl~riia ST.~~UC~R~COUN~ ~Yh pLA•
Pursuon? to the provisions of $ections 6321, 63~2, ond 6323 of the Internol Reve- Q ~
nue Code, notice is heraby given thot thare hove been ossessed under the Internol `~~v~i)
Revenus lows of the United Stotes agoinst the ~ollowing-named toxpayer, toxes f~o ~~~Y 26 PM • O~
(includiny int~rsst and pe~altiesl which ofter demond for payment thereof remoin
u~poid, ond that by virtue of the above-mentioned stotutes the omount of said toxes,
toyeth~r with penolties, interest, ond costs that moy occrue in oddition thereto, is C
o lien in iavo? of the United Stotes upon oll property ond rights to property belong- ~'n`=i '''O~TR{~S
ing to said taxpoyer. CLF_RK t CUIj COURT'
NAME OF TAXPAYER
AAZtO~t A. GR~i, Allena Will Drillin~
RESIDENCE
4318 ?venw "J", Ft. Pi~rc~, F1~ri~a••3~0
CLASS OF TAX UNPAID BALANCE
(Tox Return Form No.) PERI00 ENOED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(a ) ~b) (c ) (d ? (e )
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~ 941 6-30.68 12-26-69 59-1112201 150.31
~ 9LFl 9-30-68 12-5-69 59-1112201 387.08
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~ PLACE OF FILING I' ~ Z'SZl •UI`
' agtr• L11C~6 Ci~L1IIt.T
~ Ft. Pi~rae~ Fl~riia- TOTAL s 537.39
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~ WITNESS my hand ct ~~gt pa~ ~te~i FZ.~ri~ , on this,.
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~ rhe 21at dey of Y~.T ,1930 -
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~ SIGNATU ~ ti TITLE
~ ' ar~up 3upfr~ia~r , t 1°
~ lLo~aa C. Csa~ru
~ (NOTE: Certificote of o(fic~r outFwri:ed by low to tok~ ocknowledyn~~ms is ~ot ~ssent~ol to tM ~al~d~rr of Ndie• ef F•d•.ol Ta: Li~n G.CJrt.
3:; 26I19, C.B. 195051. 125.)
~ 8001(1S~ PAGf ~4~~
~ PART 1-To be retained br recording oHPte
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