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Form 668 DEP~R1r.~ENi Of THE TREASURY-MJfE11NAl REVEt~lE SERVKE fw Optia~a! Uae Bp R~ap~diny OA?icy
~aev, zaa~ MOTICE OF FEDERAL TAX LIEN UNDER INTERNAL REVEMUE LAWS lIEU ~N Rf ;r~ ~ -
DISTRICT u~o~,l~~ SERIAL NUMBER ~i- ~U~('
r t RI~
F~! RK C; ~;~i,~1~ E U/~~ ~
RFC~$9 Y~F.-~E:;~
Pursuont totheprovisionsof5ections6321,6322,and 6323 of the Inlernal Revenue
Code, notice is hereby given that there hovebeen osssued under the Internal Reve• ~ ob p11
nue lows of Ihe Uniled Stoles againsf the following-named taxpayer, taxes (intluding b
;nreres~ o~d penolties) Wh~ch olter demond for payment ihsreof remoin unpatd, ond ~
thot by virtue offheabove-mentionedstotutestheamount of sald taxes, together with
penait~es, interest, and costs that moyaccruelnaddition therefo, is a Iten In favor o( ~vs~1~
the U~ited Stotes upon oll properfy and rightstn nroperty bslonging to safd taxpayer,
NAME OF TAXPAYER
jMi ~~~+Ofl ~O ~
RESIDENCE
~0 Hoa 1M96
Ft Pi~ee~. 1~l 33452
t;PS~:;:~ ~..:s?NCE
KINO OF 1AX TAX PERIOD ENDED OATE OF ASSESSMENT IDENTIFYING NUMBER OF e?SSESSrnEt~t
la! (b1 i~) (dl tel
i lltio OL31.7'~ 05-2?-7r? 59~3?~ 592.19
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~ PLACE OF FIIING ~k. ~r~~t Q~t
~ $t LnOi~ Oo~ntd TOTAL ; 592.19
_ ~ Pl~aro~• Fl+otida
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WITNESS my hond at ~1• ~~'~i on thls, ~
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the ~~L dor of , 19
~ SIGNATURE TITLE
' ChLf ~ OtY~a Hraneh
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~ (NOTE: G.~~?ca~• 01 oHk•r ouMo.~•d b~ lo.+ ~o ~ok• ocknowi•dpn~•nb b noi ~ss~ntlol b th• rolidity d Noliu of F~d~?ol Tat lNn G.CIN.
26119, C.S. 1950.51, 125.)
~ PART 1-To bs r~tain~d by r~cQrding oHic~ 800K2,3y I~A~[ ~Oe~
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