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Form 668 _ ~eDanment of Ihe Treasury - Internai Revenue Senice
(Rev.Septembe~1976) Notice of Federal Tax Lien Under Internal Revenue Laws
District Serisl Number Fq OptioMl Uss by R9tOidinp ONit9
- 515~643 I981 FE~ -3 ~ ~ os
~~LEC i 'f F~CG~tIlFD
As provided by sections 6321. 6322, and 8323 of the Intemal Revenue Code, 1~UCi~Co1j~t ,~ t ~-.
notice is given that taxes (including interest and penalties) have been assessed hOGCR POITRI.S
against the fdlowing-named taxpayer. Demand for payment of this liability has CLERK ClRCUI? CC~ R~
been made, but it remains unpaid. Therefore. there is a lien in favor of the United `~`''~' `'~'~ ~~" ~'~ --- -
S ta tes on a l l prope r t y an d rig h ts to prope r t y b e longing to t his taxpayer for t he A
amount of these taxes. and additional penalties. interest. and oosis that may .rjl~•3a~
aocrue. , .
Name of Taxpayer
Resider~ce
604 N 14th SIREET FORT PIBRCS, FL 33450
Unpald Balancs
Kind of Tax Tax Period Ended Dste of Assessment IdenWytng Number of Assessment
fa) (6) (e1 (d1 (~)
1040 12•31-76 10-29-79 250-72-7214 1;009.55
1040 12-31-77 10-29-79 " " " 1,028.12
1040 12-31-78 10-29-79 " " " 1,279.27
1040A 12-31-7y 06-02-80 " " " 642.23
. _
Place of Fifi~g -
CLSRK OF THS CIRCl1IT COURT T~~ _
ST LUCIB COUHTY COIAtTHOUSB 3,959.17
FORT PIERCB, FL 33450
This notice was prepared and signed at ~T pI~~~ ~
the 22 day of JANUARY ~19 81
. on this,
Signature Title
~~1 • hw REVENUB OFFIC~
tnaK ca.r~r:e.r. a ar.e« .~rno.r:~,a rnr aw ro f~ks ac~owisd~m«~n b na ..s.r~e;.r ro u-. varwrry a Nork• a
Fvd~raf t~[ LN~e O.C.M. 2A~fo 1~541, C.B. 1?6.) -- . ~ ~~t~~
iAOC
E Pa~t 1- To be kept b~r recadinq ~, Form 668 iRev. ¢781
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