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FOn11 66H OEPARTINENT OF iT~ TEASU~Y-NTE~IAI REVENUE SERVICE Fa. Opr~wwl Uas or Recordng
~~v ~-TO? NOTKE Of ~EDERAL TAX L~! UND~ INTERNAL REYENUE UWS ~~E~iE c~
DISTRICT SERIAL NUMBER ~~R PQI = c' D
Ja~ckaoaville Firorias ~~Eatc c~acwT ~ouRT .
ECORD vEaif~EO
Pursuont to the provisions of Sections 6321, 6322, ond 6323 of the Internal Reve- t~~~~~
nue Code, noS~cP..~iMeby given thot there Iwve" been asiessed under the Interrrol ~
Revenve lows of the United States agoinst the followi~g-named roxpoyer, taxes (includ-
ing interest and penalties) which ofter demand for parme~t thereof remoin unpaid. and
thot by virtue of the obove~meMioned statutes the amount of said toxes, together with 2~;~~ax3
penalties, interest, and cosls that may accrue in addtion thereto, ~s a lien in favor of
1he United States upon oll property ond rights to property belonging to said taxpoyer.
NAME OF TAXPAYER
C6C~ dt JUa[l~ti ~ .
RESIUENCE
Rt 1 eoz l~l
Fort Pi~rce~ FlArids
UNPAID BALANCE
K1ND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~a) ~b1 Id) (eI
ioLo i2-33~.bb 2-28-69 4d?-26-2533 i263•b4
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; 101;0 12-33~-6T 6-14-68 l~ot?-26-2533 21a1.02
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~ PIACE OF FIUNG CLAl'I[~ C3TC1i1ti COlll'L
~ 3ti• LUC1! COUti~ TOTAI s
~ Fbrt Pi~ros~ Fl~orida
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N'
~ WIIIVESS my hand at 1~T~at PaLu B~aah~ ~'Lor~ids , on N,~s,
the 4~ day of ~h , 19 ~
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~ SIGNATURE TITLE
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~ THOHAS C. O~tAY~ Q~tODP SUPffitYISOR
(NOTE: Certificate of olfica ouM+wized br low to fake ocknowledgments is not essentiol to the vol~dif~r of Notice of federol Tox lien G.C.M.
46119, C.B. 1950-51, 125.1 ~ R
s= 600K ~c~
~ PART 1-To b~ r~tdn~d by r~cordin~ office
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