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F~ ~Q~ OepaAment of the Treasury - Interrtal Revenue Service
V
(Rev Septembe~1978) Not'ice of Federal Tax Lien Under Internal Revenue Laws ;
DiStrict Seriel Number FW OpfiOnaf Us9 by Reto~d~ny OIIiCY
Jacksonville ' ;''79 .~vi 12 2: 2? .
As provided by sections 6321. 6322, and 6323 of the Intemal Revenue Code, ~~~~.~~+tit%~~~QruEo
notice is given that taxes (inciudi~g inte~est and penaities) have been assessed ~RD
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against the foilowing-named taxpayer. Demand tor payment of this liabiliy has ~LERK~C~RC~~T t~u
been made, but-it remains unpaid. Therefore. there is a lien in favor of the United F;=r~*;r fi~-;~ r~ ,~4.,~~
States on all property and rights to property belonging to this taxpayer for the
amount of these ta~ces. and additional penalties. inte~est, and costs that may 45~
aocrue.
Name of Taxpayer
Charles ~ Barbara Broe~nelsick
Residence
6 Baxter Lane ~
Chesterfield, Missouri 63017
Unpaid Balanc:e
Ktnd M Tax Tax Period Ended Date oi Asaeasment IdenWying Number of AssessmeM
W [O) (e) [dJ (oJ
~ 1040 12-31-72 07-30-73 499-28-5908 0.00 -
10-10-77 " 1856.45
~ 1040 12-31-73 OS-20-74 " 0.00
10-10-77 " 6232.47
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!
~ 1040 " 12-31-74 OS-19-75 " 0.00
07-18-77 " 9234.13
~ 1040 12-31-75 OS-03-76 " 0.00
~ 07-18-77 " 880.25
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Place of Filing Q,zrk of C_rcuit Court
~ a~t. Lucie Co~u:tf Courtlicuse Totel = 18,203.30
~ Fort Pierce~ Flor'_da 3345~
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: This notice was prepared and signed at _ Clayton, Missouri 63105 , on this,
4
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~ the 13thdayof June ,~g 79 ~
~ Signature~1 , Title
v`' a~~~ ~ Revenue Officer
€ Warren E. Cross
(NotR Ce~tiliute of olficer •uthoriz~d by !aw to ake acknowt~ymsnts is not es~~nt(d fo ths validlfy W Ndlc~ ol
~
~ F~dsid Ta: Lisn (i.C.IH.28~t9, 1~541,C.B. t25.)
Pert 1- To be kept by recording oHice ' g~1~K ~aGf 1~68 (Rev. 9-78)
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