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Fob 6fi8 Department of the Treasury -Internal Revenue Service
(Rev. September 1978) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number For Optional lJss M Reco~d~ng Offics
Jacksonville, Florida 4~~~0
As provided by sections 6321, 6322, and 6323 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
been made, but it remains unpaid. Therefore. there is a lien in favor of the United
States on all property and rights to property belonging to this taxpayer for the fIlEO 4kt ; ~JfL
amount of these taxes. and additional penalties, interest, and costs that may =T. tt)C!~ ~ - F ~i
accrue. R9r. E -
ivame of Taxpayer - ~
~ T. C. & PJellie Glass D~ ~ .
24 PM ~9
Residence zbo4 Juanita Avenue 4'7430
Fort Pierce, Florida 33450
Unpaid Balance
f Klnd of Tax Tax Period Ended Oate of Amt Identlfylny Number of Assessment
(a) [6) (c) (d) (e)
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1040 12-31-7b- 11--05-?9 256-4-5921 1, 919.19
~ 1040 12-31-7? i1-05-?9 256-48-5921 1,b34.71
104Q 12-31-7g 11-2b-79 256-4.~~921 1,23b•42
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Place of Filing perk of the Circuit Court
St. Lucie County Courthouse Total = 4,'!90.30
Fort Pierce, Florida 33450
This notice was prepared and signed at Fort Pierce, Florida , on this.
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` the 5th day of December ,tg 79
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Sig ure Title
Revenue Officer
(N e: Certifica?e o/ ol! aufhorited by law fo fake acknowledgments is not essential to tha validity OI IVofica of
F Tax Lion ~.C.AI. 19, 1p50-1, C.B. 125.)
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