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Form 668 DEPN[TMFN7 OF THE TRFJ~Si1RY-JNTERNAI tE~ENUE SERVKE For Opt~o~wl Use By Reco.~ng OfFce
~~v. ~.~o~ NOTICE ~ fEDERAI TAX l1EN UNDER INiERNA! REVENI~ LAWS
f1~E0 Ay[? KfCOR0E0
DISTRICT SERIAL NUMBER ST.ItlCIE GOUMTY FL~- '
Chica~o, I12inois a0ct ~ : ~+~~~S
' CtERR C~:.i.U1T C0l1RT jl
Punuont to the provisions of Sections 6321, 6322, and 6323 of the Internat Reve. PFCORr V4'F~~tEO
nue ~ode, ootice is hereby given thot there hrne been ouessed under the tnternat ~ p ~
Revenue lows of the United States againsr the folbwing-nurned toxpoyer, toxes jinclud- ~ « 52 1 H ~Z
ing interest ond penolties) which ofter demand for poyment thereof remom unpaid, ond
thot by virtue of the ubove~mentioned stotutes the omount of said toxes, together with
penahies, interest, ond costs thot may accrue in oddition thereto, is a lien in favor of ,
the United States upon afl.properry and rights to property belonging to soid taxpayer. *76p
a7
NAME OF TAXPAYER
Donald J. Rossi
RESIDENCE -
8 Surrey Lane, Lon~ Grove, Illitiois - b0046
UNPAID BALANCE
KIPlD OF L4X TAX PERIOD ENDED ASSESSMENT DATF IDENTIFYING NUMBBt OF ASSESSMENT
~a~ ro~ t~~ cdi te~
2749 7112 08/U7/7~ 3b651,201+19b08-?2 17, ?99 .41
;
PLACE OF FIUNG
Clerk, Circuit Court 17,799.41
8t. Lucie Caunty TOTAI ;
Ft. Pierce, Florida
VvITNESS my hand ar '~aulte~an, Illinoia , on this,
rhe 18th day of October, , ~ q 72
SIG~IATUP.E „ T1TLE
Revenue Officer
.
(tJOTE: Cerf~ficate of ofiicer o~thorized by taw lo toke acknowledgmenh ~s not essenhal fo the validity of NOotR e f f al Tox lie G.C.M.
.-s26419. C.B. 1950-51, 125.) ~~CK~~~j ~~f
PART 1---To be retained by retording ofFice V~
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