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Form oS$•F Department of the Treasury-- Internal Revenue Service For Optional Use By Recording Olhce
;Rev. 2-»? Noiice of Federal Tax lien Under Internal Revenue laws enn p
D~stnct Serial No. 412919 i1L`a~48
_ _ J ACKSONY I L.~ Bk 292 PA 19 8 9 78
Pursuant to the provisions of sections 6321, 6322. and 6323 of the Internal Revenue Code. 13Vn ~~J;f Fft ~2~ ~ I.
nonce is hereby gwen that there have been assessed under the Internal Revenue laws of the U J ~i r.t G 9
United States against the fotluwmg•named taxpayer taxes Unciuding Interest and penaltlesl
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hl:,h al.i:i UC'Ilpl~~ I\Ii iiayrriClli ill~rCl'1 rG Tldlll Ui1'/ai~. {11~d ttldt by YIItUe Ut it-IC ODUYr' ~ 1 t ~ ~ t ~
menUOned statutes the amuunt of saki razes. together with penalties. interest. and cos?s F~•~ ` . : i::;, D
trial may accrue ur addlnen thereto. Is a Isen m favor of the United States upon alt pruperty _ CLc. r' t'"`""" Ci. ~ ~-T
ar,d rights to properly betungtng to said taxpayer Fi.a
Name of Taxpayer
Leroy F., Jr. and June J. Nickell 5~~~
Residence 3234 Naylor Drive
Fort Pierce, FL 33450
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Unpaid Balance
li Kind of Tax MFT Tax Period Ended Date of Assessment Identifying Number of Assessment
j (a) ibl (d) let Ifl
1040 30 7412 06-02-75 IMF 335-24-6840 1,889.20
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Puce of Filing
Clerk of Ctrcult Court
St Lucie County Courthouse Total 51,889.20
Fort Pierce, FL 33450
~ Notice of Federal Tax Lien Refilinc~
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IRSSerial Nurnber _ _ _ _ Recorder's Identification No. _
Clerk of Circuit Court, St Lucie County
Notice Filed With _ Cou1 thouse,_ Fort_Plerees__ FL__ 33450 _ Date
Taxpayer's Addre 5 13t Ave S Lake Worth, FL 3346_0__-___ _
ttterent than shown above)
signature ~ ~ Title Revenue Officer
RT M HOG
witness my hand at Fort Plerce~ Florida _ , on this.
the. 3rd day of ~1Slust . t9 78 _
signature _ /s/ G. A. Shame _Titte Revenue Officer
(Plots: Certificate of officer authorized by taw to take acknowledgments is not essential to the validity of Notice of
~ Federal Tax Lien G.C.M. 26419. C.B. 1950-1, 125.)
Part 1 • To be retained by recording otfics f300KL~ PbGE V~~