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Fwm 668 OVAi1TYEMT Oi TMf TREASU~II-INTEIIMAI 11EtlE~iUE SfI1VItE Fp? ~tiond l/se 8y R~cwdiny Qf/iq ~
(REV. 12-7e) NOTICE OF FEOERAL TAX LIEN UNDER INTERNAL REVEMUE LAwS F~~~p ~h~, 4, ~
fG~ROEC~ ~
DI TRICT SERIAL MB~R ST- ~yC~E c~uMrr Fl~i. '
~33 ~+y RQCir~ ?~1~?~~S e .
aac~O~IVU.LS, FL - ' 2 c~fQK c~~~cU~i .
P.i ~~Rn yE~.~-, COURT ,
Pursuant to ~he provisio~ af Sections 6321, q22, and 6323 of the Internal Revcnue Ef :
Code, notice is hereby given rhat there have been a~sessed u~der the I~ternal Revenue {aws + +
of ttie United States against the following•named taxpsyer, taxes (inciuding inte~est and ~ 11 1~ 2~ ~~r6
~nalties) which a~ter demand for ~yment thereuf rana~n unpaid, and that by virtue of
ihe above-merttioned statutas the amount of said taxes, together r•~ith penalt~es, interest.
and oosts that may accrue in addition thereto, is a lien in favor of the United States upon '
a!i property and rights to property belonging to said taxpayer. - - ;
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NAME OF TAXPAYER- - - }
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~ s~vics ~3~1~'O ~
RESIDENCE
PO Baa~ 1 ~'t3 - 3
Ft. Fisrce, FL 33~u2 _ ~
- UkPA1D BALANCE ~
KIN~ OF TAX TAX PERIOD ENDED Q4T~ OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT ~
ia1 Ib! lel - !d! - lel [
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91~~ 09-30-75 ~ 2-29-75 59-~ 588~ 38 ~ ~ 547.52
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PLACE OF FIUNG C1eTk Ot C1rC'ait COn1't ~
st' ~y TOTAL S
~ Ft. Pisres, IfL 3345: t547.52 ~
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( F`ti s P~~TCe~ 1+f. _ ~
WtTNESS my fiand at " ~ , on this,
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~ the_~~day of~',~7 . 19~6 ~
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S~GNATISRE TITLE " ~
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~ a. A~ sha~rpe r aroop g+nsa~er _
~ (NOTE: C~rt:licsts ot officer sudro•i:~n by lawr co ulc~ acknowlwyrrwncs is rwt ~swnti~l ro tM wlidiey of Notiu of F~r~! Ta~c L'wn G.CJN.
26~ f~. C.B. 19541, 125.1 -
PAftT 1- To be re~ained by recording ~Hice
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