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Form 668 DE?wRtMENT OF n~ iREAStItY-NTHNAI REVENlE SHVICE far optiona~l uu 8r R~c»~diny OMin
~REV. 2-741 NOTICE OF FEDERAL T~X LIEN UpDER IMTERNAL REYEMYE LAWS
DISIRICT SERIAL NUMBER :
Ja~~on~e ~ . 3~~1 .
Pursuant tothep~ovisionsoFSettions6321,6322,and 6323 of the Intsrna) ~evenue
Code, notice is hereby given thot Ihere havebeen assassed under the Internol Reve-
nue taws of ~he United Statas ogatnsl the following•named tmcpayer, tanes (tnciuding
interes? ond penalties) which after demand for poyment thsreof ~emain unpoid. and
that by ~irfue oftheabove-mentionedstatutestheamounl of said taxes, together with
per,olt~es, interest, and costs thot moyoctrueinaddlHon therefo, ls a Iten In favor of
ihe United Staiesuponoilproperfyand~lghlsto p~ope~ty b6IOflging to Said taxpayer.
NAME OF TAXPAYER ~
Koley Inc. .
Prescription Center
RESIDENCE
1223 Delaxare Avenue
Fort Pierce, FL 33452
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENi~1fING NUMBER OF ASSESSnnE?vt ~
lal k) (d) tel
941 06-30-75 9-15-75 59-14303~ $ 1,3~9.57 ;
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€ 4FCr~~, ~L~;r COURT
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~ PLACE OF FIIING Clerk of Circuit Court
St. Lucie County TOTAL ~ ~,3p9•5?
~ Ft. Pierce, FL 3345~ '
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~ W ITNESS my hond ut ~•~erCe~ FL on thts,
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ths.~h,.__doy of October . ~ q?5
SIGNATUR ` ^ ' ` ~ ' TITLE %
Jc'~ Group Hanager £
G . A . St~arps
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~ (NOTE~ Gr~~f~co~• o~ dfk•r av~hor4•d br b. a ak. oc4nowl~dyin~Ms M nol ~u~Mfol to tM .olidit~r d Notiu d F~d~?ol io: l4n GCIr?. ;
2M19. C.6. 19SaSi, 125.) ;
~ ° u 244 ~f 2458 -
PART 1-To b~ r~Min~d br r~cordi~g oHic~ S~OK
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