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;~v_ i-~o} NOTKE Of FEDERAI TAX UB~1 UNDQt MIT~NAL REYENUE IAWS ~`N.fO AND A
3~. ~uc~E cow~
DISTRtCT SERfAI NUMBER ~CER POIt
Ct.EIiK Citi~C,
- JACKSONVILIE FLOR ~,~p~p y~~~~~~
Punuanl to the prov~sions of Sections 6321, 63~2, and 6323 of the I~ternal Reve-
nue Code, notice is he~eby given that there hove been assessec under the Internal ~ 1~ ~ 6'
Revenue laws of the Um1ed States aganst the folbwing-named ?oxparer, taxes ~includ-
~ng ~nteres! ond pennlUes~ wh~ch aher demo~d for paymen~ thereof remain unpaid. and ~ A~O
that by virtue of fhe obove-me~t~on2d statutes the umounf of so~d taxes, together w~th /rrj~
penolhes, mterest, and cosh that may accrve in addition ihereto, is o 6en ~n favor of
the United States upon oll property ond nghh to ptope~ty belo~ging to said toxp~yer.
ti.'~ME OF TAXPAYER
A~i Cooper ~ ii G Cooper, Ksy~+ay Products
KE ~tDENCE
4801 South Federal HigM~ray
Fort Pi r F1 ri
UNPAID BALANCE
KIND OF TAX TAX PERI00 ENDED ASSESSMENT DATE tDENTIFYING NUMBER OF ASSESSMENT
I fal ibl ~d~ ~e~
' 941 Withholding 9-30-70 12-18-70 59-1059473 S 239.90
~ ~ -
~ 941 Hithholding 9-30-70 3-2b-71 59-1059473 163.36
~ 941 Yithholding 9-30.70 5-28-71 59-1059473 3.68
941 Withholding 9-30.70 7-2-71 59-1059473 5.00
~ 941 ~,iithholding 12-31-70 3-26-71 59-1059473 3,727.62
yGi Wichhoiding 12-31-70 4-2-71 59-1oS9473 37.27
941 Withholding 12-31-70 5-28-71 59-1059473 92.1T
941 Withhoiding 12-31-70 7-2-71 59-1059473 38.57
~ 941 Withholding 3-31-71 6-25-71 59-1059473 5,963.66
~ 941 ilithholdin 3-31-71 7-2-7 -
; P~ACE OF FILING
~ Clerk, Circuit Court TOTAL S 10,327.99
~ St. Lucie County
~ Fort Pierce, Florida
~
~ •vITNESS my hond ot Wes[ PaL B2ach~ F er d,. . o^ N?~s.
~
~
~ ihe 218t ~y of Jul , 19 71
;IGNATURE TITLE ~~~~A
s*
.s
S O. U1~ ACTING G
~ TE- Cert~ficde of officer ovN+w d br ~aw to take ocknowledgmenK is not essent~ai to the vol~dity of Not+ce of federd Tox l~en G.C.M.
26~19, C.B. 1950-51, 123.)
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~ PART 1--7o b~ r~tained br ?ecordin~ oAk~
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