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Form 668 Department of tAe Treasury - Mternal RewMw Service
(Rev September 1878) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serial. Number For opttoraf Use Dp RecadinQ Office
JacIwonville `~~3 190 i~OY -4 PES Iz~ I2
As provided by sections 6321, 6322. and 6323 of the fntemal Revenue Code, F:. ; c ear _ ,
notice is tven that taxes (includin S ~ ~ ~ ~ ~ ~ ~ f
g' g interest and penalties) have been assessed i...::.:- . ~ s
against the following-named taxpayer. Demand for payment of this liability has Ct: A L1:•~. J/1 VV:,ti L/
been made. but it remains unpaid. Theretore. there.is a lien in favor of the United i~ti:=~. ~-el~___!T
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 S~S843 ~ -
acxrtte.
Name of Taxpayer
. Rex & Paula Jean Holley
Residence
Rt. 3 Box 324
Fort Fierce, Fla. 33450 - -
Kind of Tax Tax Period Ended Oete of anent Identiftritq Number of
Assessment
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r.~ ro~ (c) rep au
1040 i2-31-7? 02-2$-80 234-28-7813 764.01
1040 12- 1-79 08-04-80 1972.50
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Place of Filing
I Clerk of the Circuit Court Tol<al = 2736.51
St. Lucie County Courthouse
( Fort Pierce, Fla. 33450
This notice was prepared and signed at Fort Pierce. Fla. 33450 , on this,
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rd ~y ~ i~ovember ,19 ~
y
Signature ~ Title
C. oran Jr. Revenue Officer
Male: Catifiufe of Officer a~rrhwhsd Dy q to take acknowfedpmenb rs erof easenfp/ fo fM tiYQNF W Noflee o/
Fetleral Tax Lqn O.C.M. 26s f 0, f fibflf, C.B. 12bJ
i Pert 1- TO be kept by rOCOrditq P~ ~ Form 668 (Rev. a78)
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