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Form ~~~ Oe(>trtment of the Treasury -internal Revenue Service
(Rev seotemher197a) Notice of Federal Tax Lien Under Internal Revenue Laws
District
Jacksonville
As provided by sections 6321. 6322. and 6323 of the Internal Revenue Code,
notice is given that taxes (including interest and penalties) have been assessed
against the following-named taxpayer. Demand for payment of this liability has
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
accrue. .
,.w,.Q ~„ . a..~aQ. I
W.D. Floxers Insurance. Inc.
P.o. Box 3271
Fort Fierce, Fla. 33450
Klnd of Tax - Tax Period Ended Date of Ass~ulnent
N) fD) le)
941 09-30-78 01-07-80
94i o3-31-?9 of-o7-80
Place of Filing
Clerk of the Circuit Court
St. Lucie County Courthouse
Fort Pierce, Fla. 33450
Unpaid Balance
of Asseasntertt
tee
2441.06
3265.26
Total ~ i 5706.32
This notice was prepared and signed at Fort Pierce. Fla. 33450 . on this,
the 24th day of November ,19 ~
Signature ~~
a.~7~
Identitylny Number
td)
59-0811142
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Mote: Corti/lure or oNicsr aufhaizad try 4iw ro tart. acknowbOprnaots b nor aasarrtiar ro rM vatidxy o/ Not/ce a1
F•d•rat Tax _LNn Q.C.N. 20+1!1, tOSO~t, C.B. f2b.) Rmr
Pert 1 - To bs kept by recordirq ~~ P~ ~orm 6138 (Rev. a-~8)