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Form 669 OEMRiMENi Of THE TQEASURY-WTEiNAI RfVENUE SiRJiCE For I U~e Recadrg O~ct
~r~v t-~o~ NOTKE OF fEDERAI TAX UEN UNDER INTERNAL REYENilE•UWS . €
DISTRICT SERIAL NUMBER OCERCPOIfi
~~ER[ CI~tCU1T COyRT
Jacksonville REa ~D vER~fiED.,~„~,~~
Pursuant to the p~ovisions of Sections 6321, 6322, and 6323 of the Interrwi Rev~ ~~C e1!
nue Code, notice is hereby given thol there have been assess..~ u~dcr the Interna! ~0 ~n
Revenue lows of the United Stotes aga+nst the following-named taxpayer, taxes (inciud- ~ iy~
ing ~nterest and penalties) which ofter demand for poymen? thereof ~emain urspaid. ond ~~sS69 ~L'
that by virtue of the obov~mentioned stotute~the amount of soid toxes, to~ether with r,~
penalties, interest, ond costs that moy acuue ~n a3~'tion the~eto, is a lien in fovor of /Y
the Unitec! $tates upon dl property and rights to property belong~ng to se~d toxpayer.
t~1AME OF TAXPAYER _
~filliam L ~ Lois IIailey
R~ssaENCE
3116 i~iemory Lane
~t Pierce F1 33450 .
' UNPAID BALANCE
KINQ OF TAX TAX PERlOD ENDED ASSESSMENT DATE IQENTtFY1~dG NUMBER CiF ASSESSMttJT
!a) lb1 k1 ldl
1040 12..31_~1 07_24_72 413-50_9626 1050. ~3
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~ PUCE OF FIUNG
Clertc. Clrcult COUrt TOTAt = 1050•~8
S~ Lucie County
Fort Pierce. Floride
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WITNESS my hond ot i•`~~ ~ , on this,
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9>y'
~ the 17th day of J~tsa 192,~ -
~ TiTLE
- SIGNATURE
~ Chief, Uffice isranch
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~ (NOTE: Certificote o of~'icer authorize y low to take ockrtowledgmenls ~s not essentia! 1p tM vafidity of Notice of Federal Tax lien G.C.M
26419, C.B. 1950-51, 125.)
~ PART 1-To be retained br recordin~ office e~K ~,~0 pf~~E~~~~
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