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' OE?i1RiMENT Of TIE TREASUt1l--R~TERNAI iEVEN~ SERVICE~ For Opfiural Uas ~ Rcao?du~y O~FCe
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~~v. ~_~o~ NOTICE Of ffDERAI TAX LIEN UND9t INTERNAL REVENUE tAYVt _~t ~yc~E c4~:
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DISTRICT SERIAL NUMBER CLfRKCC1 ;~UIT~~(~ ~
JACK30NYILLS
REC~R? %:r,tif0 r„-
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Pursuunt to the p~ovisions of Sectia+s 6321, 6322, and 6323 of the lnternal Reve-
nue Code. notice is hereby given that there have bee~ azsessed under the Internal ~
Revenue lows of the United Stotes against the following-named taxpoyer, taxes (includ-
ing interest ond periahiesj which ofter demond for payment thereof remain unpaid. and ~'K~ -~(0!, ~ 7 N,
thot by virtue of the abov~mentioned statutes the omo~nt of said toxes, together with
penolties, interest, and costs that may accrue in addition thereto, is a lien in favor of
the United States upon all propery and nghh to propectr be~onging to said toxpayer.
NAME OF TAXPAYER ~ ~Y ~
r~~~r~cE RT 3 BO~C 345
FT. PIB~tC~. FLI? 33r+50
- UNPAlD BALANCE
K1ND OF TAX TAX PER10D ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
ca~ ro~ c~~ td~ te~ .
1040 12-31t73 5-2?-74 266-52-9565 1,052.12
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~ Pv,c~ oF HuNC ag~. c~~,K c~
~ S~ TOTAL :1,052.~2 _
~ Fort Pieroe~ Flortde -
qN.
WITNESS my hand ai l"~a0l~ F~Ol'1CIa , On this,
~ llth ~ of Ju~y , 19 ~
SIGNATURE nnE
Chief, Office Branch
(NOTE: Certifiu+e of ofFicer wMwr bw ro take acknowledgmenh is na essenrid ro rhe volidihr of Notiu of Federd Taoc lien G.CJrI
z~.~9, ~.B_ ,9~-S~, ~zs., ~ R 2`,Zg ~ ~18~
PART 1-To be n/anod bn c~ordinp ofNce BOOK PA_~[
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