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Form V V V t of tM Tn•surY ~ Internd R•wew S•nic~ .
lRev s•~e,,,b.?,,9,8, Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number 4 Far opNwrl u:• br R•coetrg ornc.
aacxstariviLts - ~ i~~4 1950 NAR -4 A~ OS
As provided by sections 6321, 6322, and 6323 of the tniemat Revenue Code. FILED 1AE'riC DECOR~Eo
notice is given that taxes (including interest and penalties) have been assessed 3 R~O~GER
piTRA~~
against the following-named taxpayer. Demand for payment of this liability has CLERK CIRCUIT CO
been made. but it remains unpaid. Therefor8. there is a lien in favor of the United R CpR~ YER±F'tE0
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.
Name of Taxpayer _
Leroy Bellamy
Residence - - ,
2114 N 43rd St.
Ft. Pierce, Fl. 33?+y0
Kind of Tax Tax Perbd Ended f~ of Asasssmset IdenHryinp Numb_ er AssesmteM `
to tee to) - tcU ltu
- - - -
1040 12-3i-?8 05-28-79 z66-~a-13o8 z,733•~
940 12-3i-78 03-26-79 59-1656718 26.72
Place of Fitin
Clerk of ~ircttit Court
St. Lucie Courtly Courthouse Total = 3,1'~5•~
Ft. Pierce, Fl. 33450
This notice was prepared and signed at ~ • Pierce, F1. . on this:
the ~h day of February .T 9 80.
Signature - Title
~ S Revenue Officer 8001
Motc • omc•i .ut •d DY kw ro dAr• •cRr ow1•~lprn•ms a nor .sr«aw ro M• rtaUdly of Notb• a ~ 1
F•d~rsl UN1 .C.M. 2641 1, C.B. 126.)
Part 1 - TO b0 k9pt ~ raCOrditq oftiC+a Form 688 (Rev. a78)