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FOtm bb8 OEVAR7VlENT OF TNE TtEASU[t-WTEWAt REYEIJ:IE SEi.n~f For Op~r.+w! Ufe ~ AKwd~rg ONict
i~v ~_~o) NOTKE OF fEDERAI TAX UEN UMD~ MITERNAI REVENUE LAWS
tT. `uc~E 4uM r
D~STpCT SERIAL NUMBER ROOER POIT11~=
Jt1C~S0:": i~.E CIERK CIRCYiF i3~iMT
- RECOIID VERIf1E0....~~
r~--~~nuant to the prov~sions oF Sections 6321, 6322, c~~ 6323 of the In~ernai Rev~ ~ u~
nue" Cude, not~ce is herabr given that there hove been assessed uncier the Internof
Revenue lows of the Umted Stat+:s aga~nst Ihe fdlowing-nan`ed toxpayer, taxes (indud-
ing mterest and penalt~es) which aNe~ demond fur poyment ~hereof remam vnpaid. ond ~.~2~131
that by rrtve of the ubovemenrioned stotutes the amount of so~d taxes, together w~lh '~v{~~7-
penohies, interest, ~nd cosh thot may occ~ve in oddition thereto, is o I~en in favor of
the Umted Stotes upon ol) propery ond rigt~h to properfp belortg:ng to soid toxpayer.
:~IAhR[ Of TAXPAYER
:lill_i e Jar~es I.aFrery
RE~DENCE
2`;0~ Ave Q
Fort T.'ierce. . 331~5~
UNPAID BIILANCE
KIND OF TAX ~AX' PEpOD ENDED ASSESSMENT DATE IDEMTIFYING NUMBER GF ASSESSMENT
tol (bl k) (dl le)
! 9~}3 ~2-3~-69 03-2~-?1 59-1~~z?55 u~51~.03
~ ,?az~ a?~ 2,f~30.~3
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~ PL/?CE OF FIUNG
er~:, Clrcuit Court
x Sa~ r:t ~ uc? e:our.t,y TOTAL S G, y40~ t3E~
~ FbrL ~i.erce. ~Za.
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w~1NE5S mr hand ot _ t?~A~i .~r. th~s,
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~ rhe 13 ~hday of +~1;I , 19 7~
~
~ ~GNATURE nnE
~ Chiof. Jffice 5ranch
~ (N01E: C~rt~fica~e of o16c~r ovMw.a o tak~ «kno~ledgmr.+b n na a»ntw= w tM vobday o( Nonu of f~dud TaY twn t's.C.M
~ z~~9, c.e. ivso-si, ~~s.~ R 194 ~
bi~')t,
~ P~t ~-To b~ rNaiewd by heonlin~ oAk~ _
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