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Form 6GS OEPARTMENT Of T!~ T~FJ~SUl~f-MFBiAL REVfrIt1E SERVKE Fo? Opfiaal Use ey Rscordng OfFce
(~v 1-70) NOTKE Oi FEDNtAI TAX LD~I UND~ MITBtNAI REYENIlE LAWS
DISTRICT SBt1AL NUMBER ~ lE0 J?Np REC
JA+ACSq~lVILLE FLqtIW1 ~~.~uCtE COU
aoc~R Po~j~~:
Punuunt to the ovisions of Sections 6321, 6322, and 6323 of the Interoal Reve~ CIERK CIACUI~ ~~T
P~ REC011~ YERIFIED
oue Code, notice is hereby given that H~ere hwe been osseued under the Internal
R~,wenue lows of the United States agoinst the follawing-named toxpayer, taxes (includ- ~ 19 3~~~~3
ing interest and penalties) which aker demond for payment thereof remoin unpoid. a~d
thot by virtue of the obov~mentior~t.d statutes fhe omount of wid taxes, together with .
penalties, interest, and cosfs thot may accrue in addition therero, is a lien in favor of 26130'7
the United States upon all propery and riflhts to property belonging to soid toxpayer.
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NAME OF TAXPAYER .
RESIDENCE
218 G~rden Avenue
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT OATE IDENTtFYING NUMBER OF ASSESSMENT
(a1 lb1 <<1 ~d~
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~ 1040 Incane 12~31-72 6-11-73 382 30 2866 S 1,T98.38
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~ PLACE OF FIUNG ~
Clerk, Circuit Court TOTAL ; 1,798.58
~ St. Lucie County ~ ~
~ Fort Pierce Flcarida
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~ WITNESS ha~d at West Palm Beach~ FloricL , on this,
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r},e lOth d~y of Atx~ust , 19
SIGNATIAtE ~ '
G A SHARPE
fi- (NOTE: CertiRc.ale oF of~cer auttwraed by (ow 1o take ocknowledgments ~ not assential fo ths vdidiy of Nolice of F+~d~rd Tax tien G.C.M
26419, C.B. 1950-S1, 125.) OQQK?.17 ~3~84
~ P~ ~-To b~ rNain~d br r~oor~ino oAlu .
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