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Form 668 . ~~~T T~~Y - fo~ Optanal t/se 8Y Retording ONite
~R~v. 2•n~ NOTICE 0~ FEDERAL TAX LIEN UNDER INTERMAI REYENUE LAWS 3~3
OISTRICI SERIAI NUMBER
JACKSONVILLE
Pursuant to the p~ovisions ot Sections 6321. 6322, end 6323 oi the Intemal Revenue 3 ~
Code. notice is hereby given that there have been assessed under the Internal Reve- n~ ;
nue laws oi the United States against the folbwing-named taxpayer taxes I~ncluding m ~ ~ ~a
~nterest and penalt+es) which afier demand for payment thereoi remain unpaid. and pmi
that by virtue oi the above-me~tioned sWtutes the amount of said taxes. together w~th = ~~;,,o
penalties, interest. and costs that may accn,e in addit~o~ thereto. is a lien in tavor of "jCO~m
che Umted States upon all r w ~ z"
p operty a~d nghts to p~operty belo~g~ng to said taxpayer. ~ ~~c~
NAME OF TAXPAYER = ^
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~Ci~.L ~1t {I~:I~.~T. - ^O
HESIDENCE ~ - ~
RT 1 BO~C 701
FORT PIERCE, FL 33452
uHVaro eawn?cE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(a) lb) lc1 Idl lei
1040 12-31-76 08-01-77 265-OS-4635 $ 171.11 ~
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Pu4CE OF FILING CIer~C of Circuit Court •
St. Lucie County . TOTAt S 171.11
Ft. Pierce, FL 33450
WITNESS my hand at- Melboulne, FL , on th~s.
the 23rd day of ~rch ~ g 78 .
S U TITIE
(NOTE GrtAMate of off~csr author~sd Dy Isw to take ~cknowledgments ~s not essent~al to ths vakd~ty o' Not~cs ot Fsderal Tsa lHn G.~.M
26~19. C.B. 1950 t t25.1
PART 1- To ~R retained bv recording oNice e01~K 284 i~~[ 3~
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