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Form Department of tAe Treasury -Internal Revenue Service
(Rev.SeMember19T6) Notice of Federal Tax Lien Under Internal Revenue laws
District Serial Number For opNonar Uss btr Rsdcordinp orrice
Jacksonville 48 ~iAY ZQ ~ t~ Z8
As provided by sections 6321. 6322. and 6323 of the internal Revenue Code. ~ u
notice is given that taxes (including interest and penalties) have been assessed ~ S ~ ~ '
against _the fdlowing-named taxpayer. Demand for payment of this liability has A.E C1P _
been made. but it remains unpaid. Therefore. there is a lien in favor of the United pia vE+t~tfe._
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~t~88
accrue.
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Name of Taxpayer _
David do Ludell Hicks
Residence 1010 N . 17th St.
i Ft . Pierce , Fl 331+50
Unpaid 6alattce
` Kind of Tax Tax Period Ended Dots of As»essnrsot IderMlry?ing Number of Assent
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id+o-30 7912. ~ 0~+-07-~ 420-66-0730 253.85
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Place of ding Clerk of the Circuit Court
3t. Lucie County Total i 253.85
Ft. Pierce, Fl 33450
Jacksonville, Fl
This notice was prepared and signed at ~ on this. i
the 2~hday of April 19 80
Signature J rib Title
Chief, Office Branch
i Ma•c C•rrificar• of orticr aanom•d 6Y taw ro ak. acknowlepmana b n~ •ss•rrtid ro tM valid#y a Notlc• a
F•O•ra/ Tax U•n O.C.A/. 2641!), 1t)a41, C.B. 12b.)
Part 1- To bs kept by re~ng_ P~~~ t-orm 868 ¢Te) .