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Fonn 668 oHARTMB~f ~OE n£ tRFwSIlR1f-aJtF~lAl ~EVENUE sHVKE For qoliaNl Us ~ R~oo.drp Wia~
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PursuoM to the provisio~u of Seclia~s 6321, 63~2, and 6323 of the Internpl Iteve-
nue Code, notice is hereby given N~qt there hav~ been assessed under the IMernd ~
Revemie laws of the United Stotes agair~st the fdlo~wing-named ta~ayer, taxes;(ioclud-
ing iMarest a~d penalties) which aRer demond for payment thereof ~emain uopoid. ond '
thot by virtue of tha above~men6oned statuies the a~aouM of said faxes, together with
penaMia, interes~. and cosis that may cccrve in addfion therero, is a(ien in fmror of '
the United States upon all propery and ~gh1s ro pwpert~? be~onging ro said tqxpayer.
NAME OF UXPAYER
Ja6n A 6 Thalsa M~ol , Jr.
RESIDENCE
~aut~ 3, Boz 4517C ~
lbrt Pisree, Florida 33~?50
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal kl (dl l~l
,
~I
~ 1040 Incaa~ 12-31-70 OS-21-71 369 38 698S 667.09,
E -
PIACE OF FIIING
Clsrk, Ci=CYit Court TOTAL i 66~.09
saint Luci~ Coun~
l~ost li~rc~, Florida
WITNESS my hond ot i~ist t~la bs~b. !lo! a~ . on tha,
600K~ ~
the ~_dap of ~ril , 19 7
SIGNATUft ~E ~
~
a~
s° acr~c c~avs surs~visoa ;
TE: Caiif~ca~e of olBcer outho.' b~? low to tdce acknowledpmaMS is not asseNial w tM valid~r of Naio~ of Frdwd Tmc lien G.C.M ~
26I19. C.B. 1950-S1, 125.) ~
PAltT 1-To b~ rMain~d b~? hcordin~ ollic~ ~