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fotw 66Q U. S. TRE~SURY O(~cPARTMENT - INTERNAI REYENUE SERVKE Far Owiwl Use 8~! Recarrwy O~~ c~ S
cRev, s.eT~ NOTICE Of FEDERAI TAX t1EN UNDER INTERNAI REIIENUE LAwS Np R~CpR . ;
DISTRICT SERtAL NO. E~ A COUNTY• F~"A• {
JaoltapAti3l+s ~ypr'id~ g t~UC1E v,~RIF'•E~
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Pursuont to th~ provisions ot S~ctions 6321, 63Z2, ood 6323 oi the Interna) R~v~- ~ A(]~ i
nue Cod~, eotic~ is he~~br yiven thatthsre hov b~tn ossassed und~r ths Int~rnal 194~ i~ : ~ :
Rwenw (aws of th~ United Stot~s aqoinst th~;"-{ollowiny-nomed toxpoy~r, tax~ ~ ~y~ ~ ~
(includiny int~rsst aod p~nolti~s) whicb oh~r d~wDnd for poyn~nt ther~of r~moin~0 '
uopai~, ond thot by virtw of th~ cbove-menfion~d stotut~s th~ omount of soid toxes, ~
toqetFNr with p~nq_Ities, intsr~st, ond costs thot nay aecrw in oddition th~r~to, is ~,E~ Fo''~RA -
o lieo in fava of tM Unit~d Srotes upon oll p~opeKy ond ri9hts to p~op~rW beloe~9• k~ y,R~~~T COURT
in9 to,°~oid taxpoy~~. 1..ERK _
NAME OF :TAXPAYER
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RESIDENCE . " '
Rt. 1~ Boac 150~ ~'ort Pi~ros~ 1~a.~33h50 ~
CLASS OF TAX UNPAID BALANCE
(Tox Returo F¦xm No.) PERIOD ENDED ASSESSMENT DATE IDENT'IFYING NUMBER OF ASSESSMENT ~
(a) lb) k) (d) (t) i
I 9l~1 12/31/61 1-8..65 b5-J~-295oob 838.69
91i1 3/3~/62 1~-8.•b5 65•~-295~4 1,619.91t
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PLACE OF FIUNG t, Cpt1s''t
S~ LLC~ CO~iIItrj YOTAL S 2,~"•b3 ~
Fort Pi~ra~~ ~'3~orida~33450 . ~
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w~TNESS my hand ot T~iat r,.h H.~_ ~'InrL , on thi:,. ~
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the.$t,h-day of ~*r ,19 ~D ~
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SIGNATUR ~ TiTLE f
c~np ~perri.aor <
Ttie~as C. Cranras ~
(NOTE: GrtiFicot~ of off;e~r aurh«t:•d br low +o ~ok• ocknewl•d9w~ms is not ~ss~in7ol ro flN ~olidity of No1ic~ d F~d~ral Te: Li~n G.CJiA. }
T6I19, C.B. 195a51. 1Z5.) t
PART 1 To be ntain~d br ncordi~g offlce ~~`v ~
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