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Form 668 OE?~utrMEtar oF TnE nF/~SUer-a~rEe~t~t eevENUE SEev~CE Fo. OiRce
~r~v. ~-~o? NO~KE Of fED~tAI TAX LEN UNDBt MITEltNAI REVENI~ LAWS • u lE COilNTT ft
ROCEfi r"~2T~AS
DISTRICT SERIAL NUMBER CIERK ft3CUIT COURT
AEC~JR~ YEE?fIE~_~..~
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Pursuant ta the provisions of Sec~ons 6321, 6322, and 6323 of the Intefnal Reve- ( E6 ~.7 ~ 1~ PM ~~3
nue Code, nohce is hereby g~ven that there have been osseued under the Interna)
Revenue laws of tFie United 5lates against the folk>wing-nomed iaxpoyer, toxes (includ- 2~~4 ~,1~
ing ~nteres~ and penalties) which aRe~ derrsand for payment the~eof remain unpaid. and ,~,tz
thot by virtue of the above-mentio~ed stotutes th~: omount of wid taxes, together with ~
penai~ies, interest, ond costs thot moy occrue in addition therelo, is a lien in fovor of
the United States upon oll p~opery ond rights to propery belonging to soid tonpayer.
NAME OF ~AXP.~?YER
tllillard 8 Shirley Davis
RESIOENCE
Route 4, Hox 732
Fort Pierce, Florida 33450
UNPAlD BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal (bl k) tdl ~e1
; 1040 Income 12~31-?1 05~-29-72 267 70 622? 494.96
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~ PUCf Of HUNG
Clerk, Circuit Court TOTAL S 494.96
~ St. Lucie County
~ Fort Pierce, Florida
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W,~~: ~ch} ''loridd , on this,
F: 1M,1NfS5 mr hond at -
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~ ~ 16 h of Februar}~, ~S' ` . .
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~ THO~AS C. GPAVES GROt~ SUP S
~ (NOTE: CeAific~e of o(6cer wtn«aed br bw to toke acknowtodgments is nd esseMid ro the voliditp of Notice of Fs3~ird Tmc lKn G.C.M
~ 26419, CB. 145~-51. 125.) ~ ~ ~ ~
~ PART 1-To b~ rNain~d bp recording o1Rc~ ~`'~.K ~..~r
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