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fOtrt~ ~i6$ DEFARTMENT Of THE TREASURY-iNTED1ILL lEYCNUE SERViCE For Oprarwl Use 8r Record,ng Of~
~r~v. i.io~ NOTI~ OF fEDEltAI TAX UEfi UNDER INTERNAL REYENUE UWS ~A~ .
~Y . .
DISTRICT Jacksom-ili.e SERIAL NUMBER ~~~iK C1,~C~I~g .
itf.CbRD YfA~F~4,,..,,~,,,~
Pursuant to the provisions of Sections 6321, 6322, o~d 6323 of Ihe Internol Reve-
nue Code, not~ce is hereby given that there hove been assessed under the Ir.ternal
Revenue lows of fhe Unifed States a~ainsi the following-namec! IoxFayer, taxes (includ-
ing +nte~est ond penalties) which ofter demand for payment tFereof remain unpaid. and
that by virtue of the obove-menii~ne.~ statutes the amount of soid toxes, to~ether w+th
penalties, interest, and costs !hat moy occrue in addi~ion thereto, is a lien in fovor of 242084
the Uniteci $tates upon all p~operty ond righh to property beloag:.^.g 'o soid taxpayer.
NAME OF TAXPAYER
-.~;i~l~,ur ~
~ CLara Gri?2~
RESIUENCE 21=t =~ach Arpnue
Ft. Pierce, Ftorida ~3~~0
UNPAID BALANCE
KIND OF TAX TAX PER10D ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSM~NT
la) lb) ld) !el
10~~0 ~~2r3:tr7~ ~-29-?z z9~-~`3-730~ $t.~~7.52
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PUCE OF FILING
~ Clertt, ClrCUit Cou1t TOTAI S:L, 4~47. 52
= St Lucie County
~ Fort Pierce. Florida
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~ WITNESS my hond at ~"•i~mi, FIoY'icia , on this,
~ yL L. A SO~Y ~+VO QA~t . ( I J
~1@ lOl~l_ ~r of i~~tf~1~:`'f3r ~ ~9~`'•
~ SIGNATURE T1TLE .
Chi af, ~fficp Brar.ch
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(NOTE: Cettificote of officer o~thoru y Irnv to toke acknowledgments is not asentiol ro the validiy of Notice of Federal Tax lieo G.C.M.
26~19, C.B. 1950-51, 125.)
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PAR? 1-To be retcined by recordin~ off'ice
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