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Forst ~6{•f D[PARt'MENT OF THt UR1)' - tNTlRNAL !1!'ISNU! IERV ~ Fa gM~prl Ur. !ti R~c«~lq ON.cr ,
ctev. CERTIiKATE Of <~ERAt T' tIEN ~
DItTR~CT ~ r~Rar?L' N0.. N
i F Ufa}26Q073 B-216. 8~-2803
,
' `i her certify flat os to tM following xpeyer tM rpuir~etents of Sietieri ~ 4
j ~ 6~25(entorne) Rewnw Code, hsw#ber~i,~tis _ with nspeet fo the texe enu-o
E te~'below; together with all stet~titi*ns provided. by S.ction• 634 ands` ~ N~Y ZO ~ ~ 30~ _
~ tGet the-lien for such tuxes and stetufwy additions hos tMnby bNn reposed."TM;''. -
ptoper~Ff~eer in t1N office when noliee-~nteaal revenw tox lien w!e fifid on ~ ~
j J111S1 30 r , ~9~ is Mnby outhorisedte uio~o notion ~ w
dig hisNooks to show tM nhrose o1 sold lien,. insofor os tM limn notes fb the ~ D
fellow foxes. -
! NAMB• OF XPAYER
_ ~
LA>~ry Zfal~ll~n _ ~ .
RES16ENCE ~
$oiute 1, Bo~c 34 ~ ~ ~i
_ _ UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ATE~OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
fa) Ib) (c) (d) le
941 i~ith- 03-31-73 07-09-73 59-1380054 $12,221.89
I holding
i
PLACE OF FILING C1~1't, CiZCUit Cfx>rrt
St. Lucite 12,221.89
Fart PiAYC~
FlOtida TOTAL t
NOTICE Of fEDERAI TAX LIEN REfILIN6
419685
IRS SERIAI NUMBER RKORDER'S IDENTIFICATION NO. B-295 P-2054
NOTICE fILED WITH DATE _ 10/9/78 -
i
a TAXPAYER'S ADDRESS -~~~i ~ .
~ Ilf diffe than shown above)
SIGNATURE _ E r,.er.n 1d~e orate
t
s
t WITNESS my hand at Jacksonville, FL _ _ , on this,
i
the 5th dog ~ May 9 80 _
SIGNATURE Van E. O'Neal TInE_Chief z Svecial Proc~res_Siaff-_____- ~p
(NOTE: Certificate of officer authorized by law to take acknowl yments ii not eisentiol to the validity of Notice of Federal To>t lien
~ G.C.M. 26419, C.B. 1950-1, 125.)
PART 3-To be used for recording purposes ~ P~~~