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~REV- s•rn • NOTICE OF FEDERAL TAX LIEN UNDER INTERNAL REYENUE lAwS 1~ ~ wp RE~0RDE4 rrr -
DISTRICT SERtAL NUMBER • ~t-Llla~E COt1NTr F~~ ~i
JACK90IdVII.LE ROCER POITRAS ~ +
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Pursuant to the provisions ot Sections 6321. 6322, snd 6323 of the intemai Revenue
Code, notice is hereby given that there have been assessed under the Internal Reve- ~a4 19 i a4 PH
nua laws oi the United States against the follawing-named taxpayer tanes (including ~ .
interest and penaitiesl which after demand fa payment thereot remain unpaid. and
that by virtue of the above-mentioned statutes the amount ot said taxes, together with
penalties. interest. and costs that may accnre in add+tion thereto. is a lien in favor of
the United States upon all property and rights to property belonging to said taxpayer.
NAME OF TAXPAYER
~~c ~ ~~~s~a Yar.ES~n.R 39i8228
RESIDENCE ~
1922 ~JYAL ?AT-~M ~,IVE
F?RT P'IERCE FLC~tI~A 3 ~ .
~ UNPAI~ BAIANCf
KIND OF TAX TAX PERIOD ENOEO OATE Of ASSE5SMENT IOENTIFYING NUMBEq OF ASSESSMfNi
(aI' (bl (c) (d) lel .
10L~~ 12-31-75 O7-4I~-77 ?96-32-r0333 $1,01l~.10
101~0 12-3i-76 07-11-?7 " " ~11~.7°
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PLACE OF FIUNG
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ST. LU!:IE CGUt1T'Y TOTAL S ~~52S.S9
FrJ:tT P~,~i;E, F7ARIDA~
WITNESS my hand at , on this.
the 6~:• day of 2•Iarch ~ 9 79
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SIGNATUR TiTLE
Q'~
~ie Office 3ranch
(NOTE: CKtiticrn o~ oH'ce. autnor¢s0 by ~aw ro t+ke scknow?~dpmann ~s not essentisl to cM valdrty of Noi~u ot Fedsrs~ Tu G.C.M
26118. C.B. 1950- 7. 12 5.1
PART 1- To be rstained by recording office
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