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Form 668 Department of tM Treasury - IntarAal Rw~nw Service
(Rev.sewember,978) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial Number Fo. OpNonaf use by RecadBry orrrce
Jacksonville, Florida Qq~44 ~ Z~ ~ ~ 5~ -
As provided by sections 6321. 6322, and 6323 of the Internal Revenue Code.. p
notice is given that taxes (including interest and penalties) have been assessed R. .
against the following-named taxpayer. Demand for payment of this liability has VER~iEe
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
a«xt,e. ~ 4g3"J44
Name of Taxpayer
Melvin D. Dt~jardin
Residence _ r~~ ~ _
~X . J7 3
Mount Dora, Florida 32757
Unpaid Balance -
1(Ntd of Tax . Tax Period Ended DNo of Asaaament Identifying Number of Assebzsmartt
uu toy tel to7 a~
-6672-17 7806 04/28/80 1tMF' 220-30-55468 $ 4,435.27
6672-17 7809 06/l8/79 HIS' 220-30-5546x -18,401.32
Place of Riling Clerk, Circuit Court ~ t
~ St Iucie County
Fort Pierce, Florida 33450 Total i- 22,836.59
s .
This notice was prepared and signed at Orlando, Florida . on this.
the 17th day of , Ju .19 ~ • - t'
4
$ig ~~~o~~~~~K/r Titl@ a
~ Mi ler Revenue OPPicer l~J
Ir'1ef~ CertHkat~ of orHeer authorized by aw to ullc. acknow/edpmenb b nor essenrw to tM vdwNp a1 illorrce a .
i Federal Tax LNn o.C.M. 2dtifi. 1e50~1, C.B. f2b.) ~ .
Part 1- To bs ~ by rooordirq offke Form 688 (Rev. a78) i
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