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Fotm Oepartmant of the Treasury -Internal Raivenue Service
(Rev september,676) Notice of Federal Tax Lien Under Internal Revenue laws
District Serial Number Fo. optwnat v:a by Raeo.~ o1„c.
49 ~ 4e
,r~awuJa
As provided by sections 6321. 6322. and 6323 of the Internal Revenue Code, ~ P.E RA
notice is given that taxes (including interest and penalties) have been assessed ~ t
against the following•named taxpayer. Demand for payment of this liability has REt~fi YtR~~O t~~~_
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`~~
accrue.
Name of Taxpayer
J~C[ B. ~ Cl~OLY11 )AAVID8011
Residence
3154 18l[I'f8 VISA CT. -
pODT 8?. LTxIE FL 33452
_ ~ ealsttoe
I(ind of Tax Tax Period Ended fUsta of Assessnteet IdeMifYinp Number of Ass~ttent
W lDJ (e) (aD le)
~ 1040 12-31-76 10-22-79 103-24-5785 758.34
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Place of Filing Cleat of Circuit Court
St. Lucie County ~ Tp~ = 758.34
']<t. Yiasce, FL 33450
This notice was prepared and signed at )l~lbousne • ~ , on this,
the 4th day of June ,19 80
Sigpa_ture Title
D.~• aablat r
(NOtaC Cvremute O/ oMiaN autAON1aQ by Nw to take acknow/edpnNnb N not assantfa/ to tM vati0lfr W Notke o/
Faoaral Tas Uen O.C.M. ?a41D, 1980•t, C.a. 1?6J
Br~'1!(~~ PrGE 3 Part 1,- To be kept by recorditq oHbs, Form 66R (Rev. 9.78)