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44n651 ~
Form ~~S D.p~Atnwlt of ttM Tterasury ~ Int~tnai Rwonw 8ratvlc.
tRw.ssptumt>or1876) Notice of Federal Tax Lien Under Internal Revenue laws
District Serial Number Fo. ovNona~! use M aa+eonyinp otHe•
Jacksonville Fl.
As provided by sections -6321, 8322. and 8323 of the internal Revenue Code. -
notice is given that'taxes (including interest and penalties) have been assessed
against the following-named taxpayer. Demand for payment of this liability has
been made. but it remains unpaid. Therefore. there is a lien in favor of the United
States on all property and rights to property belonging to this taxpayer for the FIt.ED'liNf9 RECOROE~
amount of these taxes, and additional penalties. interest, and cwsts that may • ~ ~ LU C t E C 0 U NTY: FLT
accrue. - ~ ~ << <1 ``JCCE Ri F t E D
Name of Taxpayer ~~V~
. samael a,rry +79 AQR 12 PM Z • Z;
Residenop ~ . _
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12~- Dundas Court ~ Ct.ERK C1RC::IT•COUR"
Fort Pierce, Fl• 33450
unpaid Balance
Kind. of Tax Tax Perbd Ended Oats of Asesssrnerit Idsrotift?irp Ntunber of A~essment
w ro~ tee 1w a~
1010 1~-31-75 _ 4-2-79 266-20-GO76 1,119.51
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1040 12-31-76 1+-~1-~79 26G-~-t~076 1,014.30
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t Place of Filing
~ Clerk of the Circuit Court
St. Lucie County Courthouse TOtal = 2,133.81 .
Fort Pierce, Florida 33450
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This notice was prepared and signed at Fort Pieree~ Florida . on this,
the 10th ,19 79
day of Aaril
Signat Title c~(~+ ~ p~
~ , /r~ :ievenue Officer ~3y!( eM.! ~'!~G
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(r'10bc Cortifktato o/ otNtav ortzaw M bw to tak. .cknowl.dpm.nta b not auaan?tbt to tM vatlQNtr o/ Notks. W
Fawavat 7aa U.n O. .M. 26~fY, 0541, C.B. 126.)
Part 1- To be kept by recording Office Form 668 (Rav. X78)
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