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Form Department of the Treasury - Internal Revenue Service
(Rev.September1978) Notice of Federal Tax Lien Under Internal Revenue laws
District Serial Number Fa optional use by Recgdin Olfics
. ! :.i
Jacksonville
As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code. SL~L~U~C~tEpWp:~M~~TtpY~ftA.
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notice is given that taxes (including interest and penalties) have been assessed p~ ~q~ !~)!tT
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 - ~ ' -r'F t6_ ~ $
States on all property and rights to property belonging to this taxpayer for the C~,~
amount of these taxes, and additional penalties, interest. and costs that may 456494
accrue.
Name of Taxpayer
Raymond B. Hawse
Residence
215 Amy Lane
Fort Pierce, Fla. 33450
Unpaid Balance
Kind of Tax Tax Period Ended Date ~ Assssssntertt Identifying Number of Assessment
(a) (b) (c) (d) (~1
1040 12-31-76 05-23-77 262-y+-9280 4i 8.76
~ 1040 12-31-78 04-23-79 ?5.70
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Place of Filing Clerk of the Circuit Court
3
St. Lucie County Courthouse Total :494.46
Fort Pierce, Fla. 33450
This notice was prepared and signed at Fort Pierce, Florida , on this.
the 14th day of November .19 79 _
Sign~re - Title e~~~
i
C. oran, Jr. Revenue Officer
~ (Note: CertHiute of otticer authorized by law to take acknow/edpments is not essential to the w1idM o1 Notks o/
Federal Tax Lien O.C.AI. 28~1la, 19541, C.B. 125.)
Part 1,= To be kept by,recording office) Form 688 (Rev. 9-78)