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Form 668 OEPARTMENT OF THE T[EASURY-NTERNILL ~EVENtIE SERYKf Fa Opr~orw! Use By Rem.deg Ol~ce :
tREY- ~a~>> NOTK~E OF FEDERAI TAX l~! UNDER INTERNAL RENENUE UYYS '
DISTRICT SERIAL NUMBER FILED ANO RECOR ?
JACKSONVILLE ST. wciE couNTr ~~~i }
ROGER POiTRAS ;
6322, ood 6323 of the Internal Reve- CLERK CIRCUIt COURT"~ ;
Pursuant to the provisions of Sections 6321, RECORJ VERIFIED~....~... ~
nue Code, nofice is hereby given thot there have been auessed under the Internal ;
Revenue laws of the United States against the following-~amed taxpayer, taxes (includ- ~T `O 2d ~ '
ing interest and penalties~ which aRer demand for payment thereof remain unpoid. and ~ ,
that by virtue of the obove~mentioned statutes the omount of said roxes, together with '
pertaRies, interest, and costs thot may. accrue in addition thereto, is o lien in favor of i
the United States upon all properiy and rights to property belw~ging ro said taxpayer. -
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NAME OF TAXPAYER ~
Htrold BLCkelhaupt ~ • a
B&S Excavating Contractor ~ ~
RESIDENCE
4?50 S. U.S. 1 '
Ft. Pferce, FL 33452 ~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
~o) ~b) (d) (e) ~
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~ 941 09-30-73 09-30-74 59-1431846 8,539.39
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~ 941 12-31-?3 09-30-?4 59-1431846 13~388.66 ~
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941 03-31-74 09-30-?4 59-1431846 11~689.9T
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PLACE OF FIIING ~ '
ST. LUC~E COUNTY TOTAL S 33,618.02 ~
FORT PIERCE, FLORIDA
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WlTNESS my hand at peSt Pelm B@8Ch , on this,
rhe ?t day of ~tober , 19 74 ~
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SIGNAtURE f! T1TLE ~
.~~J G. ~~!'MRP~`~ i
G. A. S F Acting Gsou~p ~danager
(NOTE: CertiRcote of ofFicer ovthorized by law to toke acknowledgmenh is not asentia) fo the volidity of Notice of Federal Tmc lien G.C.M. <
26I19, C.B. 1950-S1. 125.) Q R~2 ~E ~ ~J .
PART 1-To be retained by recording office ~OQK
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