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~R~.~i~~ NOTICE OF FEDERAL TAX LIEN UNDER IlREI~lAI i~YE1WE LAWS
DISTRICT SERIAL NUMBER
Jacksonville ~
Pursuant to the provisions oi Sections 6321. 6322. and 6323 oi che Internal Revenue
~od~, ~otice is heroby given that there have been assessed under the Internal Reve-
nue Isws oi the United States aga~nst the fotbwing-named taxpaYer taxes (including 4~Q~~
mterest and penalties) which atter demend for DSYmBM thereof remain unp2id. and a7
that by virtue of the sbove-mentioned stetutes tM amount ot said texes. together with
penatties. interest. and costs that may accrue in addition chereto. ~s a lien in favor of
the United States upon all property and rights to property belonging to seid taxpeyer.
NAM OF TAXPAYER
Leroy Bellamy
RESIDENCE
2114 N. 43rd Street
F r Pi .
UNPAID 9AlANCE
KINOOf TAX TAX PERIOD ENOEO DATE OF ASSESSMENT ~DENTIFYING NUMBER Of ASS eSSMENT
lsl lb1 Ic) tdl
~I 1040 12-31-76 06-05-78 266-40~-130$ $ 536.64
~ 1040 12-31-77 05~22-?8 " 1~754.31
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~ PtACE OF FILING Clerk of Circuit Court
~ St. Lucie County Courthouse TOTAI S 2~290.95
_ Fort Pierce~ FL 33450
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K Fort Pierce~ Florida ~ . on cn~s.
- WITNESS my hand at
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~ 8th day of August J t9 78
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~ SIG RE TITIE
~ soc~ 29~ PAGE 15
~ Revenue Officer
( Grtificst: o! office? au sd b1' ~aw to take adc~ow~sdDments n not ~s~tw~ to tM vald~ty oi Notics d F~s~ Tn~ l~n G.GM -
~ 2 . C.B. 195U• 1. 125.)
PART 1- To b~ ret:,ined by recording oHice
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