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FOri11 SG8 DEIART.MENT OF T~ itEASUftt--IJTEWAI REVENlJE SERVKE For Op?~aql Use Ap Reccrdug Ol6c!
~x~v. ~.~o~ NOTKE OF ~EDERAL TAX L~N UNDER INTERNAI REYENUE IAVYS FIlEO I~ND itECOR~Ep
DISTp~T SERIAL NUMBER ST. ROCERCPOITRAS UI /
Jacksomrille ZO CtERK CIRCUIT COURT.~~
Punuant to the prov~sions of Sec~ions 6321, 6322, and 6323 of the Internal Rev~ ~ECORD VERIFtEO.~~.~;,. 0
nve Code, notice is hereby given thot there have been assessed under the Internol Q Q
Revenue laws of the Un~ted Stotes agoinst the folbwing-nomed toxpoyer, toxes (includ- J ~7 ~~~I j
ing interest ond penalt~es) which oNer demond for po~rment the~eo` remain vnpoid. and ~.}+1~ ~
thot by virtue of the obove~mentioned statutes the omount of so~d toxes, logether with
penalties, ~nterest, a~d costs thot may accrue in oddtion fhere~o, is a lie~ in fovor of
the United States upon all properiy ond rights to property belonging to wid taxpayer_
NAME OF TAXPAYER '~S A. FORBB9~
FORBFS SPIC N SPAN LAUNDRY & WRDS
P.ESIDENCE 602 South 4th Street~
Fort Pierce, Fl~orida••3345~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYItvv NUMBER OF ASSESSMENT
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{ 941 y 12w31~70 Lj"2~~1 5~'~~~7L73 72~~7v
I` 941 3-31-71 6-11-?1 59-1107293 676.39
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~ ?tACE OF FILING Clg~~ Circuit Court
~ St, Lucie County TOTAI S 1~lt0~t•29
~ Ft. Pierce~ F1s.
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= vNITNES$ my hond ot IPlast P lm Awa~h _ Flnri r~a , on this,
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THOI~L~S C
~ (NOTE: Ce.hficote of ofTicer ou~ho.aed by low to ~oke ocknowledgmenh n not asenhol to the vaLdily of Notice of Feden±l Toa lien G.C.M.
~ 26419, C.B. 1950-51, 1~5.)
5 PART 1-To b~ r~tan~d br ncordiny oAic~