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Form @~~ Oepertment of the Treasury - Internal Revenue Service
(Rev.sel~ember1978~ Notice of Federal Tax Lien Under Internal Revenue laws
District Serial Number - Fa t~tiona) u:o by Raoa?a~w aric•
J AcxsoxvlLLE 42596 0 PM 2 37
As provided by sections 6321, 6322. and 6323 of the Internal Revenue Code, s~EO ~
E~jI~A 'A.
notice is given that taxes {including interest and penalties) have been assessed etl7p'KCMIetIR DIMtT
against the following-named taxpayer. Demand for payment of this liability has VERIf~EO
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~,~6
accrue. -
Name of Taxpayer
JACK C . RAI!~1LS
Residence
1211 AVE. M
F-r. PIERCSx FL 334.50 - -
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assesa<nent Identifylny Number of Assessment
la) lb) /e) ld) ls)
~ 1040 12-31-77 12-31-79 - 267-y4-4971 944.17
~ 1040 12-31-78 6-4-79 116.24
t
Place of Filing Clerk of Circuit Court
St. Lucie County Toted =1x060.41 -
Ft. Pierce, 33450
E
This notice was prepared and signed at Ft. Pierce, F'I, , on this,
:1
the 19Th day of f4a~rch ,19 80
Signature Title
G -
~ (Notr. Cartilk;ate ottiCe/ authorized Dy law to take acknowledgments >s not assantW to t1N validity a/ Notice o1
Fadard Jax Lien .C.sI. 28~ t g, t gbt} t, C.B. 12b.)
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a....e......it......at..e P~6E dorm BS8 :Rev. x781