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Fwm 668 DE?A[TMENT OF T?IE TIEASUtr-w7ERwu eFVENeIE SElvKE For Opriond U» ~y R~eordrg OIIic~
(REV. t-70} NOTKE OF ~EDNtAI TAX l@! UNDQ INT~NAI REYEMIE LAWS ? LEO AND REcOllp~
DlSTpCT SERU1l NUMBER i~. `UCtE COUMTY flA.
Jacksuttvillo r la. OlE
~K CIRCUII'CWRT
RECORD YERIilEO~.,.~.~
Pursuant to the provisions of Sections 6321, 63?2, ond 6323 of the Inte~na! Reva
nue Code, notice is hereby given tha~ there hwe besn ossesscd under the Intarr?ol ~
Revenue lows of the United States ogoinst the following-named toxpoyer, taxes ~includ-
ing interest and pe~alties) which aRer demond for poyment thereof remain unooid. ond
thot br virtue of the abov~mentionec! stafutes the amount of wid taxes, togefher with
penohees, interest, and cosls ~hot may accrve in oddtion thereto, is a lien in frnor of
the Umted States upon oll properfy ond reghts to property belonging to said toxpoyer.
NAME OF TAXPAYER Z O7 p O y
:':iA - ~ G ioc~ac te~^ Si~t:
RESIDENCE
F.~~. ''~X ~£~2,
~'vr"•: i Pi'- RC FIAi~II:A - 33~5~
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE tOENTIFYlNG NUMBER OF ASSESSMENT
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~ y<'-_j.l 1?-31-70 3-1?-71 ~5-li0ij"2y~ y1C.OS
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~ WITNESS mr hond a1 ~'.est Palm ~Each, Floriaa , on ~,~s,
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- the ~Ut=' dop of i~arC:l , 19 7I
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s~~runx~ ,/f ~G~, ` / nT~
~C%~~~%~~(,~i ~"C~ EY ~:r~u,~ Supervisor
(NOTE: C.rtif,cw. of olFcer ovN,or~z.d br law ro rok~ ocknowl.dgmenK s na~ .s~.nrid a ~h. ~ol~d~y ~f aF F.d.r l G.C.M
Z6~19, C.d. 1950-S1, 1~5.) .
PART 1-To b~ rMaieNd br heordieq oMk~
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