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'~Form G68 DEPARTMENi OF THE TLEJISUYY-WTERNAL lFVENVE SfRVICE Fw Optionol Ute By Remrd+ng OlFice
tR~v i o->> ) NOTICE OF FEDERAL TAX LIEN UNDER INTERNAI REVENUE LAWS
DISTRICT J~~~v,~,$ SERiAL NUMBER ~
Pursuant to the provisions of .Sections 6321, 6322, and 6323 of the Internal Reve- ~ i
nue Code, notice is hereby given that there have been assessed under the Internal
Revenue laws of the United States agoinst the following•named toxpayer, toxes (ireclud- '
ing interest ond penalties) which aher demand fqr pa~ment thereof remqin unpaid. and ~
that by virtue of the above-mentioned stotutes the amount of said taxes, fogether with
penalties, interest, and cosls that moy accnle in addition thereto, is a lien in fovor of
the U~d Stotes upon all property ond rights to property belonging to soid toxpoyer_
~oaFi~P~,E~ Betty J. 9~u~erlin
RESID NCE
~l Soutt? Oceau Drive '
Fort Pie~ce, Florida 33450
UNPAlD BALANCE
KlND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSfSSMENT
Iol (b1 kl ld1 le1 -
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~ 1040 12-31.~70 W+-23-?3 2~-~~7956 ~ 1.153•92
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1LE01?nQ RECORoE0
~ -tuC~E CaUNTr f1,A, ~
E ROCE~ ?OttAAt ~1
~ tERK CIRCUI7 COUIIT ~
p _ AFC RD VEPiFifO...~r~.... ~
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~ 19 10 3~ AN '73 ~
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~ - 2~a9~
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3 PLACE OF FIUNG CLFRIC~ CSAQTIT OOUAT .
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_ ST I~TCIE OWN'1`i~ TOTAL S 1•153.92 `
F~OAT PIStCS. FlARIDA
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e~ , WITNESS mn c~nd ot , on this,
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_ the llth ~y of DsC. , 19 73•
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SIGNATURE ~E -
~ Q~iaf. OtPics Branch.
" _ (NOTE: Cert~cate of afFicer authwized by lavr to toke ocknowledgments is not essentiol fo the validiy of Notice of Fedsrd Tax Lien G.C.M
26t19, C.B. 1950-51, 125. t
i ~04~t~ s:?~ i
~ PART 1-To be retained by ~ecording oHice
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