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Fam 668 OHAlIT11BfT OF iME TIIEASI~? - MIT91N~1 IIEVBIIE Sf~YICE Fo/ OPtionsl Use 8Y ReCO/diny ONiCe
~REV 2.n~ NOTICE OF FEDERAL TAX LIEN UNDER INTERMAI REYEINIE LAWS -
O~STRICT SERIAL NUMBER
Jacks~r~ville
Pursuanc to the provisions of Sectio~s 6321. 6322. snd 6323 oi che Internal Revenue ~
Co~ie, notice is hereby given that there have been assessed under the Intemai Reve-
n~e Iaws of the United States against the tollowing-named taxpayer taxes (~ncluding
~nterest and penalties) whlch after demand tor payment thereof remain unpaid. and
cnac by v~rtue of the above-mentioned statutes the amount of said taxes, together with
penalties. interest. and costs that may accrue in addKion thereto. is a lien in favor of
che Un~ted States upon all propertlr and rights to propertY belong~ng to said taxpayer.
NAME OF TAXPAYER
Roosevelt D:~r~~.,an
AESIDENCE
1904 N. 16th Street
Fori P' r a F
UNPAID BALANCE
KIND OF TAX TAX PERtOD ENDED DATE OF ASSESSMENT IDENT1F111NG NUMBER OF ASSE~SSMENT
Isl Ib} Ic) Id)
1b40 12-3I-74 09-19-77 265-~0-7218 $ $fi9•~
; 1040 i2-31-76 ~9-I9-77 " 173.55
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~ - a~- CUCIE -~0{ilii ~L
` I ROCEA POITRAS
s ClERK CtRCUIT COUR
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~ PLACE QF FIUNG Ci~k of Circ~~it Cciiart; ,
St. Lucie County warthouse TOTAL S 1~063.07
~ Fo~i Pierce~ FL 33450 ,
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~3 W~TNESS my hand ac rort Pierce~, Florida _ , on cnis.
cne 26th day of July _ t9
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SIGNATURE TITLE
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Reven~e Officer pppK~c7~ F,~,'E
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~ ( E Cwrt,fi~ute off~ce~ auttw•asd bY ~ew to tsMe xknow~sdpms^ts n not essent~sl to tM vaMd~ty ot Noc~ce of Fedwsl Tu lwn G C.M.
2 419.C.8.1950-: s25?
PART 1- To be rotained by reco~ding office
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