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Fwm 668 DEPMTMErrt OF if~E TREASURY-NTEIRJ/LL lEVE~ri1E SEINKE For Opf~onol Use 8y Reco.dng O~ce
;z~v. ~-~o~ NO?KE OF FEDERAL TAX L~N UNDBt INTERNAI REVENI~ IAWt o
p;yT~CT SERIAL NUMBER s1 LUCIE COUNTY F~A.
JAC~csa~viLr.~. ~.~1nA ROCE~t F~~~R~S
CIERK C?RGUIT COURT
Pursuant to the provisions of Sections 6321, 6322, and 6323 of the Internal Reve- RECOR~ VERiF1E0
nue Code, notice is hereb ~ven that there hwe been assessed under the }nternol ?
Revenue laws of the llnited States against the folbwing-named taxpoyer, toxes (inctud- ~ i` ZQ
ing ;nterest and penalties) which after demand for payment thereof remoin unpoid. and
that by virtue of the above~mentioned statutes the amount of soid taxes, together with
pe~ai:ies, interest, ond a~sh that moy accru~ in addition thereto, is a lien in fovor of
the United States upor, al! property ond righh to property belong~ng to said taxpoyer. 2~102
N.AME OF TAXPAYER
~I~1Cf~0 COOk
RES~DENLE
906 North 24th
Fort Pierce, Florida 33450
- UNPAID BALANCE
KtND OF TAX TAX PEf~OD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal f~l k) ld) lel
-
! 1040 Income 12-31-71 06-29-72 263 80 9932 $ 279.76
~
~i ~040 Income 12-30-70 05-21-71 263 80 9932 245.70
i
~
PLACE OF FIUNG
~ Clerk, Circuit Court
TOTAL s 525.46
~ St. Lucie County
~ Fort Pierce, Florida
~
~ ~TME~ West Palm Beach, Florida , on ~h~s,
,
the .21Sf._daY of-~A~embez, 19'~?
s~c ruRE ~ , n~ 800K ~U PdCf 26W
S
(NOTE: Cafificate of ol~'icer authorized by ~aw M toke «krowledgmanfs is no1 esse~did to tfie validiry of Notics of Federol Tax lien G.C.M.
26119, C.B. 1950-51, 125.)
PART 1-To bo wlain~d by r~conlinp oAk~
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