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~ Fcxm 66d DEPAP.7~AENT OF THE TlfIlS1KT-INTERN~: ~VEhUE SfCYKf fw Opf+orwl Use Br Recad 0f1'~ct _
, ~r~v. ~-~o; NOiKE 0~ fEDfRAI TAX L~N UNDER WTERNAI REYENUE lAWS f Eo ~tND R[~~g
DI~TR{C7 JA(x.S01~(1/IId.S SERIAI tvUMBER 5~~~~
Q~' ~
! ECORO E~II?1 0~~
Pursuaz! to the prov~s~ons of Se;t~ons d321, 6322, ond 6323 of the Internal Reve-
nue ~ode. rtohce is Fereby g~ven that there have been assessed imder the In?emal t
Revenu~ iows of ti~e Un~ted Stotes og5i~st the following-nar:led raxpoyer, taxes (includ- Ia
' ing ~nterest ond per!ait~es) whic~ ofter demand for poymenf !hereof rema~n unpvio. and
if?at by v~~ rue of ihe cbove ment~oned st6tutes ihe amcu~t of s~id taxes, !ogether with
~ peno~i;es, ;n!erest, and costs th.~t rray accrue :n oddit~on thereto, is o tien ~n favor of
: t'rie li.~~ted Stcte; ~pon ail p~operty and nghts to p~cpetty belorg~n9 to sa!d taxparer.
; `~AME Of TkXPAYER
_ 31.and c~ Phyllis S. He1ms
~ ~~~1DENCE 719 N 4t.h St
~
FZ. Pierce. ~'L 33450
~ UNPAID BALANCE
KW~ OF TAX iAX PER!OD END~D ASSE~~NtENT rJATE iDENTiFYING NUMBER Of ASSESSMENT
- ~01 ;h) ~c) (dl I~1
Y4 i '
1040 12_31_69 1-z9-71 24L54~8021 26.12
K
:'d
~
PUCE OF FlLI~tG
CI@Ik. CifCUit COIiR TOTAI = ?_6.1.2
$t LuCIA COUnty
Fort Pieroe, Flortds
WITNESS my t~and ot 1''~lt~~. I''~OP~A , on this,
' rhe ~t.h riay of ~Ctob@I' , 19
:i ~f
- SlGNATURE i1TlE
< CHIi~ ~ CFFICS Bi~At3C'tf
- r
- (NOTE Cert~f:ca~e oF of~'Kr autho~~ze r!ow ta !oke cxknowiecfgmMls n not essentaal !o the ~o1~d~~ of Nonce of federol ToY !rcn G.C.M.
- :bti9, C B. 1950-51, 125 ~
- PART 1-To bt r~toin~d by rtcordin~ oRk~
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