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Fwm A68 OEPAAIMENi OF THE 1REA5URY - NTEBNAL REVENUE SERVICE For Optionaf Use 8y Recordiny Oilice •
~REV.'-'e~ NOTICE OF FEDERAL TAX LIEN UNDER INTERNAL REVENUE LAWS
DISTRiCT ~ SERIAL NUMBER
J~CKa90NP1I.T$ F~LED aND KECQRDEO
ST. ~~CiE COUNTY F~~,
Pursuanttotheprovisionsof sections6321, 6322, and 6323 of the Internal Revenue CLE KcC
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Code, notice is hereby given that there have been assessed under the iniernal Reve- RECOan
nue laws of the United States against the following-named taxpayer taxes (includirsg Y~g3'~€b_ i~~~ .
iritef~st anci penaities) which after demand for paymenf thereof remain unpaid, and
that by virtue of the above-mentioned statutes ihe amount of said taxes, togethe~ j 8 3 z9 PH
with ~enalties, interest, and costs that may accrue in addition thereto. is a lien in favor
of the United States upon all property and righis to property belonging to said tax- .
PaY~~-
NAME ~F TAXPAYER
ar.TOx s, Bs~sr~
RE OENCE -
~00 Sonth Indian River Drive ,
201 S. 2nd St., Ft. Pierce~ FL 33lj52
UNPAtD BALANCE
KIND OF TAX TAX PERIOU ENOEO DA7E OF ASSESSMENT IQENTIFYING NUMBER OF ASSESSMENT
(a) (D) (C; (Ql (e)
941 06-30-?6 10-25-76 59-1110032 101i0.12
PLACE OF FIUNG Clerk oY Circuit Cp~t
$t . I+tiC3e COUIItg s TOTAL ; ~^ti,~ . i 2
Ft. Pierce, FL 33?j50
WRNESS my hand at Ft• Pierae, FL . on this,
the 11 th ~y ~ Novmber . ~936
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SIGNATURE TITLE '
a' ~ C?2"O e2'
(NOTE: Certiticsta ol ofrica wt zed by law to take ~cknowledqmen4 is ~ol essential to Ihe velidity of NoUCe ot Federal Tu Uen (3.C_M.
2941~. C.B. 195o-1. /25.)
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PART 1- To be retained by recc~ding office _