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F~ ~ U. S. TREASURY ~EPAftT1AENT - INTERNAL REVEIWE SERVKE Fa. Orr.wl Uw 8p R .q ON.c~
(REV. 8~671 NOTKE OF FEOERAI TAX L~N UNpEt INTERNAL REtlENUE l~wS .
DISTRICT SERIAL NO. - -~e'~p'~4 RECORO
Jaalcso~tilL~ FLs~'l+ds - 8T. lU C 1 C OUN'fY: ~t:A:
Pursuont to tM p~ovisioes o~ Sectioas 6321, 63?~, ond 6323 of th~ Inarnol R~v~- REC D~ n V R ~ F 1 E ~
nw Cod~, notie~ is Mrebr 9iw~n ~lat fh~n hov~ bHn oss~s:~d und~r th~ Int~rno) ~~~~~5 Y
R~v~n11~ bws of tM Uoit~d Smt~s a~oinst tM bll~winy-no~d toxpoy~r, mx~s
(ieciudiny iet~r~st ond p~noltits) which oft~~ d~apn~ (o? por~nt ther~of r~moin p SEP ~ ~ 8~~~
unpdid, ond thot br virtw ot the abov~-n~+tion~d stetut~s ~he omou~t ol soid tox~s,
toy~tl~ with p~nohi~s, inter~st~ ond costs thot iMy accrw in oddition th~nto, is .
e li~n in lovor of tM United Stat~s,.upon otl prop~Hy and ~iyhts to property b~lony= ~
in9 to soid ~axpoy~.. . f~OG~R ~u~o T~
NAMIE OF, TAXPAYER _ CLERK CIRC T '
Ip~ L~OY ' '
RESIDENCE • _ '
31r03 -~sa~r ~ - .
l+~act M~ l7er~ds -
CLASS OF TAX UNPAID BALANCE
(Tax R~turn Form No.) PERIOD ENDED ASSESSMENT DATE 1DENTIFYINCs NUMBER OF ASSESSMENT
(o) ~b) (c1 ~d) _ (e~
! 94i 3-3i-7o 6-26-70 59-o9o5~zo l67~0.73 ~
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PLACE OF FIIING ;
j~p~ Q~~ TOTAL S 6~~~
~b1'tr Ma'O~ j ~+O!"i~t ;
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WITNES~ my hand at ' U1~~1 Pi7Jl1 HliOh, ~O3$+di , on this
th~ dop of ~t' ,19 ~
SIGkATU , TIT LE
~ as a~~~~e ~ Q~r aT~n~~oa
MOTEs C~r~iflc~» ~~~ie~r o~rtlwls~l ~r Ir.r t~ Kkwwl~d~eMS i~ nM ~sa~Mi~ h IA~ riIi/i* ~ NM~M M~i~n G.CJA.
~ 2~119. C.9. 19SOS1. 123.?
IART 1-Te b~ nloin~d b~r ncer~~~
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