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Form 668 ~ Department of the Treasury r Internal Revenue Service
(Rev.Septembert978; Notice of .Federal Tax Lien Under Internal Revenue Laws
DISifICt Ser1al Number Fa Optional Ute by According Otlice _
479 ~ o P~
_ Jacksonville, FL
As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, p
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 VER~~f) .
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 4825'79
accrue.
Name of Taxpayer a corporation
Ft Pierce Oxygen & Equipment Inc
Residence 650 Angle Road
Ft Pierce, FL 33452
Unpaid Balance
Kind of Tax Tax Period Ended Dais of Assessment hientifying Number of Assessment
(a) (61 (c) (d) (e)
II
i
~ O7.00
941-01 7812 01-07-80 59-0573672
E 941-01 7903 01-07-80 5,103.33
941-01 7906 01-07-80 " 3,798.85
• " 2 881.14
s ~ 941-01 7909 01-07-80 ~
Place of Filing Clerk, Circuit Court
St Lucie County Total = 16,880.32
Ft Pierce, FL 33450
I
This notice was prepared and signed at Melbourne, Florida , on this,
the 2 5th day of March ~ g 80 .
Signature Q Title
G. A. Share Revenue Officer .
(Notac Certificate of Officer authorized Dy law to take acknowledgments is not essentis/ to the validity of Notice d
Federal Tarr Lien Q.C.M. 2641 g, 1954 f, C.B. 125.) .i,~~,.~~pR~, (/V D¦z?t 5i9
o-.. , _ t.. to 4er,t Irv racnrdine AffffC~'VferV (AOC Form 688 (Rev. 5.78)