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p~~ ~Q U_ S. TREASURY ~EPARTMENT - IMTERNAL REVENUE SERVICE Fw Osr~arl Use e~ R«o.d~wy 0(I ce ~
(REV. 8-67) NOTICE Of fEDERAI TAX IIEN UNDER INTERNAI REYENUE IAwS ~
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DISTRICT SERIAL N0. ' "
San lhcanoiaco 91~01 (1~') 72577 ~ ~ f
Pursuont to the provisioos oi Sections 6321, 6322, ond 6323 0( the leternoi Reve- .f
nw Cod~, notice is hereby given thot there have b~tn ossessad under the Internol ;
R~venw lows of the United Stotes against the following-nomed toxpayer, toxes
(iecluding interest and penalties) which ofter denand (w poyment thereo( remoin ~
unpoid, and thaf by virtve of the obove-mention~d slotut~s the omount of soid toxes, ;
toy~ther with penolties, interest, ond costs that moy occrue in addition thersto, is 234'~$6 i
o li~n in iavor of the United Stotes upon oil p~ope~ty ond ri9hts to property belong-
ing to soid toxpoyer.
NAME OF TAXPAYER
~1ira' T• ~ ~
RESIDENCE
398 8ai~t strset, 84r? P'ra,~dsco Calit. 9410¢ -
CLASS OF TAX UNPAID BALANCE
{Tox Return Form No.) PERIOD ENDED ASSESSMENT DkTE IDENTIFYING NUMBER OF ASSESSMENT
(o l (b) (c 1 (d ) (e)
lol~o 12-31-69 3~26-71 548-34-9730 355.05
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PLACE OF FILING .
Clerk of the Circuit Court TOTAL ( s
~ St. Lude County 1,55.p5 ~
Ft. Pierce, Florid a
WITNESS my hand ot ~n ~~~d~ - , on this,.
the~dcy of J ,19 T2
SIGNATURE TITIE
~cor Robsrt J. Q~igl+~~ OZ!'iNr
(NOTE: C~r~ificor~ e( oFf~e•. ouri+oriz•d by law to tok~ eckne.l~dym~ms ~s no~ •ss.nr;ol ~o rM velidcrr of Ndic~ e( F•d.ral Tass L~~n G.CJiA.
26~19. C.B. 195P51. 125.)
PART 1-To be ntained br recording office E~~~ PA[~~
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