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Form 668 oEPAetMENr oF n# nlEASU~n--1NrE~tlu REVFNUE SEtv~CE
~aEV ~ao) NOTKE OF ifDBtAI TAX lldi UNDBt INTERNAL REVENI~ LAWS F` '
DISTRICT S6tIAl NUMBER ~f. 0 1lfR~
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Puauant to the provisions of Sections 6321, 632Z, and 6323 of the Interoal ReMe- _~i ~
nue Code, notice is hereby given thot there have been assessed under the Intema)
~ Revenue laws of the United States agoinst the following-oamed tmcpoyer, tuxes (includ- -
ing inMrest and penoltiesj which after demand for payment thereof remain unpaid. and 4346
that by viriue of the obove~mentioned statutes the amount of said taxes, tog~her with '
penoM"~es, interest, and cosis thot may accrue in addition thereto, is a lien in favor of -
the United States upon a!I property and righh to propery belonging to said taxjwyer. ~
NAME OF TAXPAYER
RESIDENCE
1509 Avenue 1~
u~vPao e~?uwce :
KIND OF TAX ~AX PERIOD ENDED ASSESSAAENT DATE IDENTIFlfING NUMBB: OF ASSESSAAENT
tal Ibl ki idl (e)
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' 1040 Income 12-31-65 08-16-68 266 S4 6158 S 396.32
~ 1040 Incove 12-31-66 10-24-69 265 54 6158 435.21
lavo i„come 12-si-67 1a24-69 268 5a 615s 300.38
~ 1040 Income 12-31'-68 04-13-69 266 S4 6198 230.26
1040 Incooe 12-31-69 04-15-TO 266 54 6158 239.74
PLACE OF RUNG
~ Clerk~ Circuit Court TOTi4l i 1 601.91
~ St. Lucie Covnty ' -
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yy~TME~ st Palm Beach. lerida , on this,
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- the~t~d~ of 1~+~ . 19 T~
~ 7iTLE
• GA~ SI~IItVISQt
(hIOTE: Certificde of oA'~oer auMiorized br law ro take odcnowledgmenls is nw essen6 vdidity of Not6c~ of Fedral Tmc tisn G.CJ1h.
26t19, C.B. 1950-S1, 225.~ ~ r~
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PART 1-To bo nfdned bp ncor~n~ oAka
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