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Form ~~~ DepaAment o/the Treasury - Internal Revenue Service
Notice of Federal Tax Lien Under Internal Revenue laws
(Rev. September 1978)
District Serial Number
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J ACKSOIt1/ILLE J
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code,
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notice is given that taxes (including interest and penalties) have been assessed
against the foltowing•named taxpayer. Demand for payment of this liability has ~~p VfMFIfO
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 `~ ppnn
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accrue.
Name of Taxpayer
MAYNARD 0 ED)fARD6
Residence
204 SOUI~i th STREET FORT PIERCE FL
Unpsid t3alsnce
Kind of Tax Tax Period Ended Date of Assessment Identiflltrtp Number of Assessaent
[a) [b1 [c) ld) lam)
1040 12-31-79 06-16-80 223-8+-7590 909.11
Place of f=cling
CLERK OF THE CIRCUIT COURT
ST LUCIR CWNTY CWRTHOUSE
FORT PIERCE, FL 331+50
Total ~ =909.11
This notice was prepared and signed at FORT PIERCE, FLA , on this,
the 2.4th day of NdVF~(F3F.R ,19
Signature
lints o/ oltkM aurAOiued
UaA O.C.M. 2d1/Q 1 sa541,
v
~ hW RE1fENUE OFFICER
law t~k~ acknowl~dymanb !s not ossMtfal fo tM vaUdittr o1 Notiw o/
..B 126. 8ao~4 p~ g~
Part 1- To be kept by retbrdinp office i _ Form 668 (Rev. X78]
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