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Home My WebLink About0628 ~ f Z I F~ ~ U. S. TREASURY ~EPARTMENT - INTERNAI REVENUE SERVIC~ ~ Fw ~:wl Use Br R~cv~:ig +~c~ T. (REV. &67) NOTICE OF fEDERAI TAX UEM UNDE~ 1lITERNAL REYEN.UE LAwS DISTRICT ~ SERIAL k0. ~t : daakson~rille~ !'Lorida ' . . 7~LUCI~ C4U~1~1f~~~ ' Pursvont M t!N provisions of S~ctioas 63~1, 63u, ond 6323 of tl+~ lnt~rnQfl Rev~- RECORD VERIFI~d nw C4d~, notic~ is Mr~by yiv~n thot th~re hqv~ J~tto oss~ssed und~r th~ Int~rnol ; R~v~nt~ kws of the Unit~d Stotes a~oinst tb~ #bllowinq-nomed taxpoysr, tox~s 1gt~S9 ' (inciwltn~ int~r~st and p~nalti~s) which aftir d~na fo? paym~nt ther~of r~nain ~ 6~~ 9~ g~ uopoia,;and tiwt by virtw of fh~ obove-ineetio~d atatut~s th~ amount of said toxss, - to~tlN? with p~nolti~s, inttrtst, ond costs thot ~aiy occrw ie addition th~r~to; is ~ a li~n in favor of-1M Unit~d Stot~s upon oll prop~ny ai~d ri~hts to properry Mlony ~ : in~ to:#oid taxpoyer. - ° - RQGER P A$ NAME OF.~AXPAYER - . -LERK CIRCUIT COURT~ Haaic~ll ~ndsreoa _ Y £.1 . . ~ . t RESIDENCE ~ ' _ - 915 ~ng3~ Ro~a ~ - _ - ~ ~ Fort Pi~s lrl~orlda - _ CLASS OF TA'X . • UNPAID BALANCE ;Tax R~turn Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT " 2 (a) ~b) (e) ~ (d) ~ 2290 6..30.68 9-19-69 31 b95 249091~01 ~t05.97 ~ ; 2290 6-30-69 9-19-69 31 695 211a9o91A0 19~6.97 ~ ~90 6-3a70 9••19~-69 31 695 24900L01 150.00 - I - - ~ - ~ - . s. ~ - 4 4 ~ } ~ ' ~ ~ # ~ r~LACE OF FILING C~1'~[, Ci2~CY3,t. COII!'tr - ~ $t,~ j~~~ ~py~{~ TOTAL s552•94 ~Ol'tr ~.~I~OA~ Z'~I'~di . : 3 ~ , • ~ WITNESS my hand m ~a'~ pa~ F~1'3~ ~ , on this,. ' the u~ doy of ~ ,19_~ - j SIGNATURE TITLE . ?~K~ ri • ($iAOiB ~ ~kODP $Up~~IB~! (NOTE: C«r~f~~o~. ei oifs~.~ a?rM.is•d br Im. +e fala eckna.l.dys~nts is not ~ss~Miol to fh~ roliditp of Ndic~ ef F~d~rol Twc 1,i~n G.C~1, 2~19, ~.B. 195a51, 145.) g oK~85 P~ 628 PART 1 To b~ ntain~d by ncording offic~ _ . _ ~ ~~x ~ ~ ~ . . _ . .