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Form Department of the Treasury -Internal Revenue Service
(Rev.Septambert9Ta, Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number Fa OptionM Us• Dr R•cordirq orrics
4~h128'7 i
Jacksonville, FL
As provided by sections 6321, 6322. and 6323 of the Internal Revenue Code. 5 CPO~I~~~A.
notice is given that taxes (including interest and penalties) have been assessed CHIT 6lIMt
against the foilovring-named taxpayer. Demand for payment of this liability has ~w~~~
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 'x~~,1~8'7 :
accrue.
Name of Taxpayer
Arliss id ~ Vicki L Graves
Restdenc:e 1320E 38th S t, Apt 8
Davenport, IA 52807
Unpaid Balance
Kind of Tax Tax Period Endod Date of Assessment Ides Number d Assessment
a~ cep co) cw c•~
1040-30 7812 Ob-04-79 2b1-7b-b412 712, b2
Place of Filing
Clerk, Circuit Court
St Lucie County Total = 712. b2
Ft Pierce, FL 33450
This notice t+vas prepared and signed at Melbourne, Florida . on this,
the 30 t:~ ~ ~ May 19 80 •
Signature p~ Tdle
G. A. Share Revenue Officer
tNot« c•.reriur• a oHicw .uthoriz•d by law ro rak• acknowr•dpm•nrs nor •saarHU ro tM vdidlfy o/ Notk• of
F•drd Tar Lien O.C.M. 2Alrsa 1e641, C.B. 126.)
BQ:l~~ i'~ 8 Part 1 - To be kept by rocordkq office`, Form 66d (Rev. 9.78)