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Form 668 OEPARTYENT Oi ~HE TREASUHY-tNTERNAt pEVENUE SERVICE For Optio~wl l/se By Rerording Of/ice
~REV. ~2-~a~ NOTICE OF FEDERAL TAX LIEN UNDER INTERNAL REVENUE LANIS ~~~py~~~~ ~
DISTRICT SERIAL NUMBER L °
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Pursuant to the provisions of Se ions 6321, 6322, and 6323 of the Internai Revenue
Code, notice is hereby given that th e have been assessecl under the Internal Revenue laws ~
of the United States against the following•named taxpayer, taxes (including interest and jj
cenalties) which after demand for payment thereof remain unpaid, and that by virtue of
the above•mentioned statutes the amount of said taxes, together with penafties, interest,
and costs that may accrue in addition thereto, is a lien in favor of the United States upon
al! property and rights to property belonging to said taxpayer. _
NAME OF TAXPAYER 32617~
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:f~'1l~l~i CL/.iS11iV 1111~1:1 Ci J::~~~:~7Vlllii.l' 1 ~JO~LL • "
RESIDENCE
2201 : r'ui ~t id. ~ `
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tor~ SL. ~ucie, :Z 33l:52
UNPAID BALANCE
KIND OF TAX TAX °ER100 ENDED OATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
la1 fbl Id Idl !el
~L-~~-~~. 3-L~,-7i ~;'-i5~~~1:~ '
~'.c 1 ~-~1-7 2-21-7~ , ,E.~
??:1 3-31-~~ 12-~-75 3~?•5~ .
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~ PLACE OF FILING ~r,~ a~ '~i, cui', ~~o~sr ~
~ S LuCie Co'ar.~,: TOTAL S ~ ~ 87 .~7
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~ ti"~I TNESS my hand at t t. Pierce, _ _ , on this,
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~ the 2?ric~iay of J~'Z~z~T , 19 7F•
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~ SIGNATU E TITLE ~
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(NOTE: Cerhticate of offirer aWhonrecf by law to take acknowledgmeMS is not essential to the val~dity ot Notice of FWeral Ta: Lian G.C.M.
~ 26419, C.B. i950 1, 125.1
~ PART 1- To be relained by recording oiEice
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