HomeMy WebLinkAbout2941 Form 65R DEiA1tTMENT OF THE l~E~ISUr-MEO~tAI ilEVENUE SEIMCE For Oprono~ Use BY R~co+dng OrF.ce
~t~v. ~-'u~ NOTICE OF ifD~tAt TAX L~1 UNDQ MiTBtMAI REYHi11E UWS -
~~STftlCT SERiAI NUMBER
J acksomi3.lle
Punuant to the prov~sions of Sections 6321, 6322, and 6323 of the Internol Revd FI~ED I?MD RECORCE~
nue Code, notice is hereby given thot there have been assessed under the Internal ST. lU,~' "'~+ITY FLA.
Revenue tows of the United Stotes agairKt the folbwing-named taxpayer, to~ces (includ- RO~t TaAS
ing interest and penolties) which aher demand for poyment tt~ereof remain unpaid. ond C~E=~ ~ :''1T COURT ~
thot by viriue of the obovementioned stotutes the omouM of w~d ioxes, together with R~ r^: R-• p,~~
pe~alties, interest, and cosfs that may accrue in addition thereb, is a lien in fwor of 9 21 MI7 ~~Z
N~e United States upon all properfy and rights to property belonging to said toxpay~er.
NAME OF TAXPAYER s2
Gti s and / or r'1 erence RnQ ers
RESIDENCE 6411 So. Indian ~ver Drive
, Ft. Pierce, r~1a 33u5o
~
UNPOJD BALANCE
`t KIND OF TAX TAX PERIOD ENDED ASSESSAAENT DATE IDBJTIFYING NUMBER OF ASSESSMENT
~a~ ro~ c~~ ~d~ ~ei
3
~ io4o 12.31-7~ 0~1-16-71 339-16-7625 2519.95
~
i9
-+1
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'x"s
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PLACE OF FIUNG Clerk, Cir~uit Court
5t. LuCie CounLy TOTAL s 2519•95
= Ft. Pierce, Fla.
.
- WITNESS my hond ot s*„i ~ s on this,
' the _~{j~. day of J at7. 19 ~2 -
~t,`~~~ ~~rVW
SIGNAT, U~E T1TLE
_ _ _ Chief. Office Branch
;tv7TE: Certif~wte of officer o~thwiied by law to toke «knowledgmenb n not essenf~ol to the vcl~d+ty of Not~ce of fede~a' Tox l~en G.C.M.
2h='9, C.B ~950-51, 1?5.j
- PART 1-To be retained br reco~ding o{i'ice