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For1n OepaRment of tAe Treasury -Internal Revenue service -
(Rev Septemt>.<,s,8, Notice of Federal Tax lien -Under Internal Revenue Laws
District Serial Number _ _ For owlorw use Dl~ 1~eeordinp office
Jacksonville -
~9T9 SFP 27 - P~4 ~ 16
As provided by sections 6321. 6322. and 6323 of the Internal Revenue Code.
against the ffoliowing-named taxpayer~t Demand for pahyment of thb
s/ iabii s~,~G~
POINTR
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been made. but it remains unpaid. Therefore. there is a lien in favor of-the United C'ERK CtACUiT Cpu -
States on all property and rights to property belonging to this taxpayer for the ~
RECQRD YERIFIfG
amount of these taxes. and additional penalties. interest. and costs that may
accxue.
Name of Taxpayer _
Herrt~ L i3obce J. Iill
Residence
3 ~~ve K -
Ft. Fierce rl. 0-
Unpaid Balance
Kind of Tax -Tax Period Ended Date of Assessment Identityirlg Number of Assessment
[a) fb) fc) fd) fe)
1040 12--3?-77 i1-13-7~ 25b-4~-15t~8 3,077.41
Place of Filing
Cl~r:, of the Circt~i~ court
:,t. I~cie Coc-~nty Total i 3, ~J',1.4i
?is: ce, 1. 33%+5 -
This notice was prepared and signed at r
fierce, Fl. . on this.
thalst. day of .19 79 •
Si re Tdle -
'l n •r
~ertifics a of officer a ;zed try law to take acknowleopments b not essentla/ to tlM validly o! Notice a/
F I Tax l.len fi.C.ll. 2t1Ii , 1 50.1, C.B. 12bJ (~.1~
aA.t 1 . Tn t>B Iceet l~v recording Form 668 (Rev. 9-78)