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' Fp~ ~d U. S. TREASURY ~EPARTMENT - INTERNAL REVENUE SERVICE For O~~oMi Ust 8~ Reca.J.e~ OH~ce
(REV.B-67) NI~TICE Of iEDERAI TAX llEli UNDER INTERqAI REYENUE IAwS ~ -
DiSTRiCT SERIAL NO. FILED ANO RECORDED
JacksonQills !'].~orida ' ~ T. LU C 1 E C 0 U NTY. FL~ . ~
~ ~nRI) ~.'~'~~~`~-~2 '
Pursuont to ths provisio~s ot S~ctions 6321, 63Z?. ond 6323-of the Int~rno) Rev~- ~ q '
nue Codw, notice is Mreby giv~n that there hov~ bten ossessed uoder the Int~rno) ~`~`~`~V t
Rsv~nw ~aMrs .of tF~e United Stotes against th~ followin9-oomed toxpoyt~, taxss q .
(inciudin~ int~rest and penolti~s) which oft~r d~apnd for .poyment tbereoF ~~main ~ L•~ P~ 3g ` _
unpoid, ond that by virt~ie of th~ obove-m~ntioned stotut~s th~ omovnt of said toxes, ~ w__, ~
toy~th~r with p~noltits, inter~st, ond costs thot wey accrw in odditiow thereto, is - ~ ;
o li~n in fovw of the United Srotss upon oll prop~rty and riyhts to propertr belonp- 'tC!rF_~ i'OIT~
in9 to soid wxpoy~r. CLERrC CIRCIl~T COURT
NAME OF TAXPAYER ~B~T & JO~HD~ BAC~= _ ~
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RESIDENCE _ C8~ Caj~1blW~ ~1tr~ " ;
~'ort Pi~rae~ 1rl,orlda•33450 - _
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CLASS OF TAX ' UNPAID BALANCE ~
(Tox R~turn Fwm No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(a ) ~b) ~c ) ~d ) (e I ~
i~tithholding Tu 3/~V' ~W la/~1~~ 77~"~17~1°~ ~>770~~4
~I ~.00~ PeY3~8~.ty . '
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PLACE OF FILING C > C C11~f'. COqTti ~
$t• 1i11C~9 CdUR~ TOTAL S 6~TT~~64
Fort Pierae~ Florida .
WITNESS my hand at Ys~t~~_Hr~^~_ ~~+*'i~s , on this,.
ths~L.#~._dey of J~ ~ ,193Q
SIGNATURE TITLE
4'3~Ollp $tl~l`tI~~OZ' #
Thcsaa C. Graves
MOTE: C~.~ificot~ of of(ic~r ourFwri:~d by Io.r to tok~ ockno..l~dy~~ers is not ~ss~ntcel ce th~ volidiryr of NWie~ d F~d~rol Te: Li~n G.C.M,
26~19, C.B. 195051, 125.) 6~~~ ~ ~flf1
PART 1 To b~ ntained by ncording offic~ -
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