HomeMy WebLinkAbout1642 Form 669 Df:IuTTMFNT Of TkE TRfASUYY-p~TE~NAt RfvfNUE SfC~1~E For OWwal Ute ey Aec~rd~~+g OfPw•
i2~v i.?:~~ NO1Kf OF fEDERAI TAX il~1 UNDpt INTNtNAI REYENifE LAWS
DlSTR1CT Jackeonville~ F~• SERiAI NUMBER
' lE0 AM c RE .
~ Punuanl to the provisions of $ecl~o+~s 6321, 6322, and 6323 of the Internal Rev~ ~~~R~~'E!! ~
nue Code, notice is hereby g~+~~ that there have been ouessed under the Internal tfRK ClRQ~ T~~~
Re~enve Icws o{ 'he lln~ted States ag~:nst the following-named taxpoyer, to:es (includ- 0'~~RiF1Ea~~
~ ing ~nterest o~;J pen~'t~es) wh:ch ohe~ demond for poyment thereof rema~n ~paid. and ~o ~~~1~'
£ thot by virtue of the above~mentioned statutes the amount of said toxes, t ether with
~,enalties, ~nterrst, and costs that mey occrve en oddit~on thereto, ~s o lien ~n fovor of
" the Un~ted $tares vpen ail propertr a~d righis to pro~ty belonging to said taxpaye~. ry~
~
l~s1
t~~AME OF TAXPAYER
FAHI, CAR1~iIN, JR.,
- Earls Service Station
3
; RESIDENCE
5001 S. Federal Hxy.,
- Ft. Pierce~ Fla.-33450
uNPa~ a~uwcE
KIP1D OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIi~IIING NUNIBER OF ASSESSMENT
= (b) 1~1 (dl t~l
3 _
'-5
91~1 6-3a71 9-i7-71 59-u63454 515•31
y=
:~7
- .j
~CE OF Fiur~G Clert, Ciraui ~ Court
St. Lucie County TOTAL S~15.31
Ft. Pierce~ Fla.
~-z
on M?is,
WITNESS my hand or j?last Pala? Beach~ Florida
: fhe 1K~dor of ~ctober , 19 71
o
SIGNATURE T1TlE
~ / ~ aroup 9uperriaor
Thoma~ . r~ ~
` jNOTE: CerM~cWe of olf~cer outhor~~d b7 {aw to t_ke «kno~~edymenh ~s not essenhol to the vahdrty of Nol+u of Frd~rd Te~ lien G.C./Ml
?M19, C.B. 1950-51, 1[S.) gQQX19~ ~164i ~
PART 1-To b~ ntoin~d by nco?din~ o1ik~
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