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F«m 668 oerNrr~rn oF n+E rnEwsu~r-rrt~~ ~ st~wce ~ Opiaw~ Uw er~R -
t~v iao~ NOTKE OF FED8tA1 TAX L~1 UNDEt WTERNAL REYEMlE LAWS •~fItEQ AN F~ • L
~ '1 st, ~uc~~,c o~r~e~s,
[~ISTRICT SERIAL NUAABER RO~eE~- _
Rf_CORO vER
F E T ~RT
Pursuont to the prrnnsioru of Sections 6321, 6322, and 6323 of the Internal Revs t
nue Code, no6ce is hereby given that there have beer? assessed under the Intemol ,~g~+ Ol
Reve~ue laws of the Un~ted States agoinst the folbwing-named taxpoyer, taxes (includ~ `«47~ _ ~
ing interest ond penalties) which aRer demand for payment the~eof remain unpaid. ond '
that by virtue of the obove-mentioned statvtes the amou~t of said taxes, f~ 264391 ;
penalties, interest, end cosis that may accrue in oddtion there~, is a lien in favor of
the United States upon all propery and righh to pro~ty belonging ro said M~ayer.
NAME OF TAXPAYER
RESIDENCE
4635 33rd Ave ,
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UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIF1fING NUMBER OF ASSESSAAEM
Ia1 t~1 (~l ld1 ~ Iel
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~ 1040 12 -31-b7 08 -LO-73 263 -92 -0378 249. 23 . - -
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' 1040 12-31-68 08-10-73 " " 185.42 -
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~ 1040 12-31-69 08-10-73 687•~ ~
~ 1040 12-31-70 08-10-73 " " ~~•73
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~ 1040' 12 -31-71 08 -10 -73 " " • ~
1040 12-31-72 08-10-73 " " 297•~+
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-~'~Ef-6F-HNP'^-
q~' ~ TOTAL s '
` ~ 2,350.65 -
Fort Pler~oe. Florlds
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~ WITNESS my hand at ~ , on this,
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~ the t Rrh doy of c~tn~l+or , 19>~
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~ SIGNATURE T1TLE
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~ , Chief Office Branch ,
~ (NOTE: Cutilicate of ofi'icer aithoriz aw ro take xkrawledgments is nd essentid to the volid;ty of Nohce of Federd Tax Lien G.C.M.
~ 26419, C.B. 1950-S1, 125.) R \
~ PART 1-To be retaned by recording ofFKe ~
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