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Fw~ bbi-F U. S. TREAStIRY OEPARtMENT - tnTERw~i REOENUE SERVKE ~o. Qr+~m s ~ R~cord~ ON~c~
;~EV. ~:-an NOTICf Of iEDERAI TAX l1EN UNDE~ INTERNAI REYEpUE lAwS St lyGE ~p~, ~L~
DISTRICT SERIAL NO. ~CfR PQiT{{~S
n~~~ CIRCQIT ~p~
~ ID 210619 B193 ~431 ~~~D v~R~F~FD
Pursuont to th• p~ovisions of S~ctions 6321, 6322, ond 6323 of tF~e internal Reve-
nue Cod~, notic~ is hereby given that ther~ F~ov b~~n ossess~d under the Internol '
Rsvenue (aws o( the United Stotes ogoi~st the following-named toxpoyer, toxes
(includin9 inte~est and penolfissl which ofter d~mond for poyment thereof remoin
unpoid, and thot by virtue of tl~e obov~-mention~d s~otut~s the omount o1 soid toxes, 21~~
rogether with penal~iss, interest, ond costs thot moy oce~ue in oddition thereto, is
o lien in (ovor of the United Stotes upon oll p~operty and rigtits to p-oper+y ber'o~g-
ing to soid ta:poyer.
NAME OF TAXPA`.'ER
A11d=Mf ~ill ~
RESIDElJCE ~
2729 Sonth 2Sth Sts~st _ ~ ~
Fort Msru llor:da 33~?50
~ UNPAlD BALANCE
TAX FORM NUMBER PERIOD ENOED ASSESSMENT DATE iOENTiFYfNG NUMBER OF ASSESSMENT
(o ) (b 1 (c ) (d ) (e 1
1040 Inca~t 12-31•64 3-18-66 258 20 0881 S 119.50
`
~
PUCE OF F7LING
Cl~rlc, Circnlt Coust
SL• ~iC~! _~:OYDt~ TOTAL S 119~~
lort M~sca, ~lorida
NOTICE Of fEDERAI TAX LIEN REfIlIM6
IRS SERIAI NUM6ER S9~OS__ RECOR~ER'S tDEh1YIFICATION NO.
Clssk, Circnit Co~rt
NpTICE FIIED WITH $t. _ Lsci~
COY~1Ljs_ ~OlL _HltC~t--~10l~~11 ~ATE ~9-71
TAXVAYER'S ADDRE - - _ _
difEerent liwn shawn Qbove) ~
si~NwnjRE - - - - • nnE _~~P S_p~s~risor Collsctiou Di~. ;
- . _ _
~
~ -
WITNESS my hand at ------Y~it2~_Bt~C~t-F~t1da - - - - - . on this,
the . _4Lh-_dap of ~1it~ _ _ 19.71 _ _ `
SIGNATURE TLO~is C. -C!ri!S- - TITIE ~~p Sopss~risor ~
iNOTE: Cer~ificote oi officer ouH?orized by law to i~ke ocknowledyments is not essenriol Io the volidity oi Nofite of Ftderal Tox Lien
G.C.M. ?6~19, C.d. 1930-1. 1?S.) SS
~ R~~ 1~~ PART 1-To be ~efained br recording offic•
RCOY • i