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ONMtY91f Oi 11E i~f11SIM~ - MIT6~l ~1f8M~ SEMY~E fo? OPiions/ Use By Retording ONios
~Rfv.~t~-i~~ NOT~E OF FEDERAL TAX LIEN UNDER INTERMAI REYENUE LA~t
OISTRICT J~~ ~ SERIAI NUMBER 4S~SQ
~7
Pursuant to tAe provisions oi Sections 6321. 6322. and 6323 oi the Intemal Revenue
C.ode. ratice is herebY 9iven that there have bssn assessed under the Intemal Reve- ~a19 J~~! ~ 2 ~~i 27
nua laws oi the United States against the folbwing-named taxpayer taxes tincluding
interest and penalties) which after demand for payment thereof remain unpaid. and ~~~xU.kc coaUEO
that by virtue of the above-mentioned statutes the amount of said taxes. together with ~,~;UCIE CO!liiiTlGf1~.
pensltiss, interest, and costs that may accrue in addition thereto. is a lien in favw of ~~y~ ~.p~TRAS
che United States upon all property and rights to propertY bebn9~~9 to said taxpayer. CI:Ei~(~IttClriT C~
NAME OF TAXPAYE~i n"CC :'"'I"'!"~ - ~
ant~mr L. dc vera aohnbon 4512~9
RESIDENCE U~e C~• ~
Fbrt Pies~ce, Florlda 331~52
UNPAID BALANCE
KIND CF TAX TAX PERIOD ENDEO OATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(a) lbl ~ Icl ldl ~ Isl
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i lOlaO 12-37.-75 11-06-78 419-1t8-5yA0 1,502.99
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' 101~0 12-31-?6 11-13-78 419-48-5Y00 1t,852.06
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PIACE OF FILING CLBNS~ ~T
~ ~Z TOTAL s6~355•05
FO~P PT~CS, FLORIIaI
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~ ]f18Wd~ lrlol'1ds . on this.
~ WITNESS my hand at
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~ 2~d ~y of Jnas , 1979
SIGNA TITLE
ACl'IN(~ CHIEF, OFFICS BRA1T(~
~ (Mp~- pt offics~ sutf+waed by ~sw to t~ks a~icnow~edpm~nts ~s not ~sssnt~sl to tfi~ vaMdtY o( Not~os d FsdNal Tnc L~en G.C.M.
z~.,e.~.g.,~o-, ,z5~ ~~312 ~GF17~9
PART 1- To be retained by recording office Bfl'~
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