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--Fortn 668 oEr~utTMErJt OF iHE ntfwwtr-HrEilrtu RErErruE SEtvKE FOI OpfDf10I Uff ~ RR~~ Q~FK~
(r~v 1-7a~ NOTKE OF ifD~Al TAX U@! UNDQ IMT~NAL REYENUE LAWS gT~LU~IE CQ
EUf~sM~'+~, .
DIS7RiCT SERUL NUMBER ROCER POITRI~
•CLEM(.CiRGUii;p~
~R£CORD ~~tERlf
Pursuant to the provisions of $ections 6321, 6322, and 6323 of the Interna) Rava
~ue Code. notice is hereby given thot there hove been assessed under the Internol
Revenue laws of the Unit~+d Stotes against the following-named tozporer. toxes (intlud-
ing interest and per?aN~es) which after demonci for pa~nnent thereof remain unpoid. and
that by virtue of the above~mentioned stotutes the amount of said taxes, togethe~ wiM A '
penolties, inte~es!, ond costs thot moy occrue in ad~tion thereto, is o lien in fovor of ~a7~1
the United States vpon oll property ond righh to propery belo~ging to said M~vyer.
!~1AME OF TAXPAYER
Florida Gycl~ b l~ar~r Bntsrprisu Inc.
R~SiDENCE
3800 South Pod~ral Aighway
Fort Pisres, llorida 33430
l~1PAID BAUNCE
KIND OF 7AX Ti?X PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(~l (bl k1 ldl (e)
941 Nithholding 03-31-70 11-06-70 59-1271629 ~ 270.31
941 Nithholding 09-30-69 I1-06-70 59-1271629 507.1s
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~ P'u~CE Of FIUNG
= Clsrk, Circuit Court TOTAL i 777.46
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~ St. Lnci~ County
Foirt Piares~ Florida
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; v~nn~ESS ,~,y ~w~d o~ ilest lila Dsach, l~lorida , a, ~,a,
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~ ~!~e.~Zpd doy of ~sb~, 19 71
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R SIGNATURE `i~~ T1TLE
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;'G TAO!!A8 C. CRIIVEB GAOUP 8Ur~HI80~
~ (NOTf: Certi6cal~ d o1RcK a?thorwd bp law to tok~ ocknowledpm~nb is nd ~~n1id to IM rol~di~r of Nolic~ of F+idMd tax li~w G.CJrI
2M19, C.B. 1950-S1, 125.) ~
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~ VART 1-To b~ htain~d by r~eoed'in~ oRrc•
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