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~AEV- z-»? MOTICE OF FEOERAL TAX l1EN UNOER INTERNA~ REYENUE LAMIS
DISTRICT SERiAI NUMBER 3~~ •
Jacksonville ~ ~
Pursuant to the provisions of Sections 6321. 6322. bnd 6323 of tha Intemal Revenue -
Code. notice is hereby . given that there have been assessed under the Internal Reve-
nue Isws of the United States against the following-named taxpaysr taxes Iincluding . v..~
~nterest and penalties) which after demand fo~ payment thereof remain unpsid. and ~
that b~y virtue of the above-mentioned statutes tAe amount of said taxes. together with ~ ~R o ~o
penalties. interest. and costs thet may accrue in addit~on thereto. ~s a t~en in tavor of c; +;n;
the United States upon aN property and rights to property belor~ging to said taxpayer. '%z'
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NAME OF TAXPAYER w
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Shirley R. Douglas = ~~..1. ~
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RESiOENCE
2706 Essex Drive ~
Fort Pierce FL 33450
UNPAID BAIANCf
KIND OF TAX TAX PERIOD ENDEO OATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMEHT
Ia! Ibt Ic) Idf (el "
1040 12-31-75 03-20-78 226-22-6640 $1~252.37
1040 12-31-76 03-20-78 " 1~036.44
1040 12-31-77 03-20-78 " 794.43
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PtACE OF FfLIMG C1erk of CirCUit Court
St. Lucie County Courthouse TOTAL S 3,083.24
Fort Pierce~ FL 33450
WITNESS my hand at Fort Pierce, Florida , on ch~s.
~ 27th day of ~rch ~ g 78
SIG TUR TITLE '
l E. ~rv(~cste ot ffic~ authoraed Dy Nw take acknowledgrt~sn no~ essent~sl co the vahdty oi YotKS ol ~edrrol Tsx i,en G C.M.
9. C.B. 1950- i. 25.1
P RT 1- To be rotained by recording off'rce $~f~~/~ ~~f
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