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448381 ~f ~
Form 6s8 ~ Qepartment of the Treasury -Internal Revonue Service
I
:Fev.Sepiembert978: Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number For ORt~ona! Ute by Aecordeng Oft,ce
JACKSOINILLI; I-- - ftlEO Aria FiCOxaEO
As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, S ROGER
POITRA~A~
notice is given that taxes (including interest and penalties) have been assessed CLERK CIRCUIT C C
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 !?[CORD \'E°.tf(£^._
States on all property and rights to property belonging to this taxpayer for the
amount of these taxes, and additional penalties, interest, and costs that may ~ 448381
accrue.
Name of Taxpayer -~j
JAI•~S A, ~ MARY DAVIS ,
Residence -
3110 Avenue C
Fort Pierce, FL 33450
UnpaW Balance
Kind of Tax Tax Period Ended [late of Assessment Identifying Number of Assessment
k ra) [b) re) ld) (e)
f
E 1040 12-31-76 11-27-78 ~ 266-24-6268 103.50
I 1040 12-31-77 5-29-73 " G75.06
1040 12-31-7Z; 5-14-79 " 429.15
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Place of Filing Clerk of Circuit Court
St. Lucie County Toted _
Ft, Pierce, FL 33450 907.71
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This notice was prepared and signed at. tielbourne. FL , on this,
the 7th day of June ,19 79 - .
Signature Title
_ (Crandn 1
Mote: Cerrili is of olNter aulAorized by taw to take acknowledgments not asssn I fo tAa vabdity of Notice of
' Fadoral Tax O.C.M.264t9. tli54t,C-B. f25.) fj ~ f1~O w~~~
Part t - To be kept by recordirp oft~ce• Form 668 (Rev. 5.78) j