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oe?~~rtr oF n+F reEwsuer-rrtEa~ ~vE+rue ~ for opiwol u,. er R.oord~ng orRce ~
DI ~REV. t-6701 MOTI~ Of FEDBtAI TAX ~~aiiBtNAI REYEM~ LAWS ptlQC~IE Cp UN
~ C}~RK CIRCUIT CAOa{MT
REco1tD YERIfIEOi,~
PursuoM to the provisioru of Sections 6321, 6321, and 6323 of the Internol Reve-
~ue Code. ~ofice is hereby given that there have been assessed vnder the Intemal
Revenue laws of the Un;ted Stotes agairat the following-nomed taxpayer, ta~ces (includ-
ing intexest and penalties) which aNer demand for poymsnt tt~eof re~rwin unpaid. ond
thot by virhie of the above-me~tiw~ed statuies the amount of said taxes, rogelher with ~~8~!~~
penolt'~es, inierest, and cosis tlwt oeay accrue en oddition thereto, is a lien in favor of ~ C~ti~,K'"-
the United States upon oll prop~ty anci righh b p~operty belonging b said b~ay~.
NAME OF UXPAYHt .
Ja~es Bert Ool~y
J B Oolsy Paintiag
RESIDENCE
3505 Avsaue F
~'ort Pierce, Floridit 33450
~Pao ~?u?r~cE ~
KIND OF TAX TAX PERIOD ENDED ASSESSAAENT DATE IDENTIF1fING NUM68t OF ASSESSMENT t
tal lb) kI (dl lel '
i 941 Nitbholdi 03-31-68 12-31-71 59-1028795 $ 686.61 {
i 941 Withholding 06-30-68 12-31-71 59-1028795 690.44 f
~ 941 WitLholdiug 09-30-68 12•31-71 S9•1028795 531.59
f 941 NitLholdiag 12-31•68 12•91•71 S9•1028795 725.21 ~
~ 941 illthlaldius 03-~1-69 12•31-71 59-1OZ879S 676.63 ~
941 Vitbholding 06-30-69 12-31-71 59-10'18795 1,122.61~ ~
941 Vit6bolding 09-30.69 12-31-71 59•1028795 l,O8S.06 ~
941 Vit6holding 12•31-69 12•31-71 59•1A28795 1,OS5.93
941 Wit6bolding 03•31-70 l2-31-71 59•1028795 1,172.38 ~
941 Wit6lalding 06-30-70 12•9I•~1 59-102$795 1,012.1~
441 iiit6holding 09-30-70 12-31-71 59•1028795 589.06
941 Nithholding 12-31-70 12-31•71 59•1028795 209.60
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1
~ PU1CE OF RLINC
Clerk, Circuit Court TOTAI = 9 557.29
~ St. Iuci~ County '
~ Fort Pierca, Florida
~
~
3
Vy~TNES$ nr~r hand at Yast Pal= E~~?, Flerid. , on 1his,
~ 3rd. ~ Ma~r , 19 ~Z • ~
~
~ ACTIIi(~ CAGUP S
(NOTE: C~cde of oR~oer au ' by low to tob acknowkdpimnls is no~ ~ntid b N~t vdiddy of Nwia~ of Frdrd Tmc ti~n G.CJnI
46419, Cd. 1950-S1, 125.)
PART 1-To b~ r~tain~d b~r noordina oAlc~ 4001(~~ PAGE ~3
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