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Fom~ 668 DEPJIRTMENi OF TF# i~EASU[Y-NiEiNAI REVEMUE SEtVKE Fnr ONliora~ Use QI' Reoord~ng OJFite
~r~v. ~-~o~ NOTICE Of fEDERAt TAX LEN UN08t WiERNAt REYENUE LAMIS r ~Eo ~aa ytc~R~EO
:~.luCiE couN r
DISTRICT SERIAL NUMBER ~OC~~ , ~ITA~S
Jacksonville, Fla. C~EaK t:c~~~j couAt
- - - ~ nr~:ear~ ve!~~~~ce..,....~-
Pvrsuant Io the provisions of Sections 63?i, 6322, and 6323 of the Internol Reve-
~u:: Code, no•~:e is he:eby given that there have bcen assessed unde~ ihe internat ~
Rcvenue laws of the United States ogainsf the fdlowing-nomed taxpoyer, taxes (includ• 12 a6 PH .
ing interest ard penalties~ which aNer demand for paymeN ~hereof rem~in unpaid. ond ~QCr~O~t
that br virtue of the above-mentioned stolutes the amount of wid toxes, together with ~~r~~V < <
pena~t~es, interest, and costs that may acc~ue in aid~tion thereto, is a lien in favor of _
the United Stotes o n all and ri hh to a bel i to soid to er. ~
~ rN~c~r ~ ~ ~ ~^s ~?s ~r ~
NAME OF TAXPAYER
D~nzie Roy Ford '
Ford I~asonry Contractor _
RESIDENCE - •
2803 Langston Dar. ~
Ft. Pierce, Fla. 33450
~ UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal IbI k1 ~d~ ~e~
~ 941 03-31-i~ OS-26-T2 59-1211194 ~2,924.98
941 06-30-?1 04-04-?2 59-12111~4 1~376.43
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~ PLACE OF FlUNG Clerk~ Gircuit Cc~urt
St. Lucie County 70TA1 t 4,301.41
Ft. Pierce, Fla.
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~
F a , on this,
~ WITNESS my hand at palm BeaCh 1.
~ 28th af June , 1974
- ~~w?nmF ~ nnE
~
G. A. Sharpe A
(NOTE~ Certifitde of officer authorized bY bw to take oclc^owted9me^h K^°~ ase"hd f° ?he vd~d;lp oF Plotice of fedsrd Tax li,;r. G.C.M
26a19, C.B. 19~0-5i, 125.) ~ ~
PART 1-To b~ relain~d bp wcordinp afiico
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