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Form 668 OEPARiMENT Oi THf TREASUNY-IMTERNAL REVENUE SERYICE Fo~ qpt~onaf Use By Recording OII~ce
(REV. 12-741 NOTICf OF FEOERAL TAX LIEN UNDER INTERNAI REVEMUE LAWS ~
DISTRICT SERIAI NUMBER
Jacksonville
Pursuant to the provisions of Sections 6321. 6322, and 6323 of the Internal Revenue
Code, notice ii hereby given that there have been assessed under the Internal Revenue laws t~. a .
of the United States against the following•named taxpayer, taxes (including interest and ~ y
penaltiesl which after demand for payment thereof ~emain unpaid, and that by virtue of N:~ T,,,~~,~•
the above-ment~oned statutes the amount of said taxes, together with penalties, ~nterest, eT ~~°c~~
n'~z
and costs that may accrue in addition thereto, is a lien in favor of the Un~ted States upon ~
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all property and rights to property belonging to said taxpayer. '~~~o~
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NAME OF TAXPAYER • a °f ~
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Eric W& Katie Le~+is ~ ~
RESIDENCE ' ~~e29 Q' ~tl~ '
2T07 Ave M, Fort Pierce,Fl. 331t52 i ~y
, ~ ~ UNPAID BALANCE ~
; KINO OF TAX ~ 7AX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER ~ OF ASSESSMENT
~ (a! lb1 !c1 Id) !e)
i 1040 12/31/69 6/~lt/76 263-92-2460 77.2b
lU!?o 12/31/70 6/11?76 263-92-2460 946.03
F 1040 12/31/71 b/7/?6 263-92-2460 1189.93
~ 1040 12/31/72 6/7!?6 263-92-2460 974.68
' 10~0 12/31/?3 6/7/76 263-92-2li60 1194.1?
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} PLACE OF F~LIWG Clerk~ Circuit Court
_ St.Lucie COUnty~ ~ TOTAL~~382.07
= Ft.Pierce,Fl. I
WITNESS my hand at ~lan~~~• , on this,
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; the ~sday of_J~ . 19 ? -
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~ SIGNATURE ~ TITLE
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~ . H. KINS GROUP MANAGER
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- (NOTE: Cerhficate of ofhr.er authonred by law to take xknowledgments ~s not esse~t~al to the val~d~ty oi Notice ot FeAeral Ta: l~en G.C.M.
T6419. C.B. 1950 1, 125.) '~R ~i_,~_ ~
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~ PART 1-To be reta+ned by rccorair•q c~:ic~ Pt~~ rV~/ P~
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