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DeM~MdR OF nE lOEASIMY - lNT9~t ~EYE~E for OP~1 Ust 8Y Reco~diny ONicf
iR~ - NOTICE Of fEDEtGI TAX L~q UNDEit NfTERNAL REYEIWE UUMi
DISTRICT Je~~~~ SERIAI NUMBER FI~E~ Aq0 AECOA~EO ~ t/~
tT• lUC1E C4UMTY FIA.
ROCER PptTRAS T~
CIEeK CIRCUIT COURT
Purwant to ths provisions oi Sections 6321. 6322, snd 8323 oi ths Intemsl Revenue ~ ~.f„~~ED
Code, notics is he~eby given Mst there have bssn essassed under the Intemal Rsve-
nue laws o! ths United States sgainat the tolbwing-named taxpaye~ tsxes (induding ~C s+ s3 PN ~'7
inter@st and penaltiss) which after dsmand for payment thereof romain unpaid. and
thac by virtue oi the above-mentio~ed ststutes ths amount ot said tazes. together with
penalties. inte~est, and costs thst may accrue in addit~on thereto. is a lien in favor o~
the United States upon all property and ~ights to property belonging to said taxpayer.
NAME OF TAXPAYER ~
' ~4~
RFSiDENCE ° 2~4 ~ '
FT. PIBRC~, FLOBTDI~? 33~So
UNPAI~ BAUNCE
KIND Of tIV( TAX PERIOD ENDEO DATE OF ASSESSMENT IDENTIFYING NUMBEN OF ASSESSMENT '
Isl (bi (cl (dl Is1
ZOLtO 12~31~75 10-03-7~ ~~••68-l~,582 1~1tl09s811.
1040 12-31-?6 - 1Q-03-?? l~27••68••l~,582 1,609.87
PLACE OF FIUNG CLg~~ ~~jT O~AT
~T• ~TY TOTAL s3,019~71
F08T PIBRCB, FL()RTDA
WITNESS my ha~d s~ xr~~rr, FLnRTi?A , o~ ~n~s.
the 7 87'Nsy a! 19
SIGNATURE TITLE
r
(NOTE: w t otficer b~r bw 6o t ts a nw Mssntial to tM vsbdrty of Not~ca d F~daal Ta~c t~n G.C.M.
28419. . . 95 : 125.1
PAFiT 1- To be retained by rscording offics d~OK PA~E
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