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Form 668 Department of the Treasury -Internal Revenue Service
(Rev.Septembert978) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number 4'7,p410 For Options( Use br Recording Ollice
JACKSONVILLE, FLOaIUA
As provided by sections 6321. 6322, and 8323 of the Internal Revenue Code,
notice is given that taxes (including interest and penalties) have been assessed ~
against the following-named taxpayer. Demand for payment of this liability has ,
baen made, but it remains unpaid. Therefore. there is a lien in favor of the United 4~0~0
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
accrue. FIIED AN.? I•~ :.~~~EO
:T t11CIF F11_
Name of Taxpayer CAE
rf r~ 1 ' C4
l~R
:.LLIED CO.dCIiEZE SUPrLY COHP ilECOp' -
a cor ration ~ 11 220 P~ Ip
Residence nT 4, B0~ 195 1
FORT PIER FLOiiIDA 33452
~ Kind of Tax Tax Period Ended Date of Assessment Ider+tifying Number - of~Assessment
(a) (b) (e) (d)
941 03 33-7y 10-01-?9 59 1b7755b $ 1,662.54
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Place of Filing
CLEEtK, CIaC+~IT CU'.I~T,
ST. LUCIL COUNTY Total = 1,662.54 -
FORT PIERCE, FI4RIDA 3:L.50
This notice was prepared and signed at FOiiT I~?CLEFiLl41.L, FLGitIDiA , on this,
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F the 4TH day of OC~~ ,19 79
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Signature y Title
1 ~VSNL~ OFFICER
.rCPEiiT E. iJAL'ILFt
(Note. Certilicats of ollicer authorized by law to take acknowledgments is not .ssential to the validity of Notice of
FedsraJ Tax Lien o.C.lil. 2tHfg, 1g5a1, C.8- 1T5.) ~ /~~r