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HomeMy WebLinkAbout1040 . - _ _ . _ _ _ _ - . . _ ~ 1~~ K~ U. S. TREAStJRY ~EPARTIIEtIT - 111TERNAI REVENUE SERV1tE F~. ~~orllhe a R~crr1.M ON.~e (RE~. d~67) NOTKE OF FEOERAI TAx t~ WIOER INTERNAt RErENYE LA~S ~~p DIST~tICT SERIAI NO. - JI?CZSONVII.?~S _ ~ t Pwswnt w th~ ~mrisions of S~etions 63~1, ~3?2. end 6323 of tM in»~ne R~w- yER4/~ ~ ew Cei~. notic~ is Mr.br yiwe tlwt /h~n hev~ liye ass~ss~ und~~ th~ (n»moi R~vM~ kws oI tM Unit~d Stat~s s~einst 1M f~llarino~ewa~d taaporir, Mx~s (iwcludiny inqr~st a~d p~eolti~s) ~rhich ofNt dqw~d ior por~M tMnof naain uepid,.~ed ~her br virtw oi tM ~bow•~tion}d stotuNS tM oawunt of soid tox~a, ` to~etM? with p~nolti~s, int~~~st, ond eosts tlwt a~ aeerw in odditioe~ tMnro, is = _ a liN? in iavor of t~ Unit~d Stat~s upon all prop~~tp and riybts to prop~rtr b~lonf• . iey to `a~id ta:pa~~• • NAME OF IAXPAYER ' _ Jaass L. arxi Bevs~sy J. Stiith RESI~ENCE io6 s. 35~ . ~ • . ; Fort Pieroe r ~ CLASS OF TAX • : UNPA10 BALANCE tTax R~tvrn Forw No.) PERtO~ ENDED ASSESSM~NT DATE IOENTIFYING NUMBER OF ASSESSI~AENT (e) (b) (e ) (d ) ~ (e) ~ ' 1040 12-31-69 05-29-?0 264-ob-5148 1.614.42 ~ _ ~ ~ f . I ~ - . i - ~ - f P~ACE OF fiLlNG ~j~•]~~ ~•~it COtlt•t ~ Saint Lvaie ~'iOt1A~/ TOTAL f 1~61~i.~i2 ~ - Fort Pie~ce. Florida ~ ~ ~ wi7NESS mr hmd ot llorids , on th~t,. ~ - ~ th• 4~ dey of Ja~~ ,19 SiGNATURE TITLE C• B. 'r~~ ~ ~I~ . UIOTE: G.riiic~ d dttsM ~ Iw M ti~ ~tknwbipMn~s Js nM ~~~~ntl~l t~ M~ r~INltp ~t NM1c~ J F~el TM Lhw O.C.M. ~.s. „~s,. i037 i89 ~E ~ART 1 T~ b~ nloi~d ~r ncar/inr ~Miu ~r~ ~ 5 z ~ . ~ • _ -h a,~,'~`~Y.-. ' ~ ~s.t^~- . e~~°~~~'w~S~ ~ . ~ ~