HomeMy WebLinkAbout1479 Fw~ 68i•F U. S. TREASURY DEPARTMENT - tHTERN~~ aEvENUE SERVKE fo. Ow~o/,~I Use By R~c>d~~p OH~ce
~~bn NOTICE OF FEDERAL TAX IIEN UNDER INTERNAI REYENUE LAwS
. ~ . F~~EO ~r,o EcoaoE
DISTRICT SERIAL NO_ iT.LUC~E C~UMTT -
193111 B-184 P-1231 IIOCEtt POITRAS
JACKSONNILLB FI~QRIDA ~~ERK CIRCUIT COU
Pursuant to th~ provisions of Sect~ons 6321, 63?2, and 6323 of the i~~e~~ai ae„~- RECOAO ~E1uiK0
nue Code, ~otice is hereby given tfiot ~here have be~n ossessed u~der ths Internol *
R~venue lows of the Un+ted Stotes ogoinst rhe following-named ta:poyer, toxes "4S ~ 1t
(~nclud~ng i~tarsst ond penoltiss) which ofter demand (or poyment -the~eof remo~n -
unpo~d, ond thot by virtue of fhe obove-ment~oned stotutes the omount of soid to¦es,
togethe? w~th penolties, ~nterest, o~d costs thut mcy accrue i~ odd~tion lhereto, is ~ eh q O~
o I~en in fovor o1 the Un~ted Stotes upon oll p+operty ond right: to property belong- ~ 1~
~ng ro soid toxpoyer_
tiAME OF TAXPAYER
R ESIDENCE
Post Office Boz 1659
Fort Pisrce Florida
UNPAID BAIANCE
j TAX FORM NUMBER PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) (b 1 tc ) (d ) ie 1
i
f
E
f 1040 Incom~ 12-31•64 S•14-65 198 O1 3371 $ 384.83
~
6
4
i
's
5
~ -
aLACE OF FILING
& Clark, Circuit Court
~ TOTAL ; 3$4~~
~ $C• I~iC~t COIlAL3t
x Fort Pisrca, l~lorida
~ -
~
~ NOTICE OF FEDERAL TAX lIEli REfIlIN6
~ - _ _
~
~ IRS SERIAI NUMBER S9~OS RECORDER'S IDENTIFICATION NO.
- Pisrce, rlorias
~ NOTICE FILEO WITH C1l1'IClC~TCll1t ~~Nlt! $t._ L1lC~• GO~l~ACI~ FOl'~ ~ DATE 3•31~71
~ - . _
TAXPAYER'S I10DRE55 _ _ _ _
- differenl than shown above)
~ SIGNATURE _ _ _ _ _ _ _ ' TITLE C'~~~~~upllylsOY~ COlitction Div.
~ WITNESS my hand at illSL P~~i_B/taC~l~ _Fl0=1di - , on rhis,
" rhe_~Lb day of I1a~_ 19 TO .
~Y Thosaa C. Gravu Grou Su svisor
SIGNATURE TITLE P Pe
e<
= NOTE: Certiiicafe o1 oHice~ authorized by law 1o toke acknowledqmen?s is nol •ssentiol to the ralidity of Notice of fcderol Tox lien
} r C.M. 76119, C.B. 1950•1. 125.) pb
,
^s 6t/i/R
PART 1-To be retoined by recordi~g offics
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