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Form ~C~ Department or the Treasury -Internal Revenue Service
(Rev.sepcemher1978) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number ~ For ope~aw u:a br aecordiny orrice
JttC)iCMO~NVILLIt
- E Nf
As provided by sections-6321. 6322_. and 6323 of the Internal Revenue Cade.
notice is given that taxes (including interest and penalties) have been assessed Q
against the following-named taxpayer. Demand for payment of this liability has. f
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
amount of these taxes. and additional penalties. interest. and costs that may 4~~a~2
accrue. .
Name of Taxpayer
OZIS )~liDBRSON
Residence
2608 Walker Dr.
Ft. Pierce, FL 33450
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assessment Mentiry?ing Number of At~essment
la) f6) lc) (d) b)
li 1040 12-31-76 3-10-80 254-48-9357 806.35
~ 1040 12-31-77 3-10-80 " 166.49
1040 12-31-78 3-10-80 469.37
Place of Filing Clerk of Circuit Court
St. Lucie County Total = 1 442.21
Ft. Pierce, FL 33450 '
This notice was prepared and signed at Melbourne, FL , on this.
the~rd day of _~1
ril ,19 ~
Signature Title
(For Crandall) Group Manager
i Mocs: certificate or ~ autnorizeO Nw ro rake acknowfedymants n nor euenrw ro me variOr7y a Notk:e or
Federal Tax Uen Q.C.M. ?8a t 9, r 6150 f, C. .125.)
Part 1 - To be kept b1l recordirq office ~ p~ Form 668 (Rev. 9-T8)