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Form Department of 1M Treasury - tnternat Revenue 8ervke
tRe,,.septembe.t>a~8, Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number Fo. oortonar v:• ~ Hecordinp onlc•
Jacksonville, F1
As-provided by sections 6321. 6322, and 6323 of the Internal Revenue Code,
notice is given that taxes (including interest and penalties) have been assessed • FIL~®-,AND RECORD
against the following-named taxpayer. Demand for payment of this liability has l./~~
been made, but it remains unpaid. Therefore, there is a lien in favor of the United ST. I.UEIE COUNTY: F'
States on all property and rights to property belonging to this taxpayer for the R ~ C O R D V c t~l l+l E D
amount of these taxes, and additional penalties, interest, and costs that may 4~~W
aaxue.
Name of Taxpayer ~ Q~ y ~ ~Z ~ 36
James 'riortham ~ -
ROuER rQiTf?~S
Res' CLERK CIRCUIT COURT, =
2~ tJ. 25t'~ Street
Fort Piercer Fl. 33450 ~ -
unpaid ealarK~
Kind of Tax Tax Period Ended Data of Assea:trtent IderWfyirq Number of Assessment
lU /6J lc) ld)
j lO/~D is-31-75 03-05-79 - 426-78-842b 1,550.91
1040 12~-31-76 03-12-79 426--7g-g426 1,7.1a5.b2
lOt,O i2-31-7? ~ 03-26-?9 426-78-8426 515.72
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~ Place of Filing
Clerk of the Circuit Court
St• Lucie County Courthouse Total = 3,212.25
Fort Fierce, Florida 33450
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This notice was prepared and signed at Fort Pierces Florida , on this,
the• 2nd day of Aoril ,19 79
Sig Title
Revenue Officer
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« c«nnear• onic« .ur ~z•d br raw ro rs~• aeknowbdpm•nn rs iar ro rM ~.rtduy a Naie• a
Tu ~ .c.~,. z~.r~. r. c.a. rz~., ° , ~F118S
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Part 1 - TO bo kept by rtticordlrq office Form 888 (Rev. a78)
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