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Form 668
DepaAment of the Treasury - Internal Revenue Sarvice
Notice of Federai Tax Lien Under Internal Revenue Laws
District Serial Number Opf af e rd~ng Ufhce
5~8'795 ~~ ~,r~~Q ~ ~ m )~; ~ ~
Jacksonville, FL ~ LEp pM~ F~c01t 0
s r Uc'E COIMiY fl A.
A s prow de d by sec tions 6 3 2 1, . 6 3 2 2, an d 6 3 2 3 o f t he In terna) Revenue C o de. i~ E R P O I t R A S~
notice is given that taxes (including interest and penalties) have been assessed t~.C~ ~~~~~ C~
agains t t he fo l low~ng-nam e d taxpayer. D em a n d for paymen t o f t his I~a bi h t y h~s E~-, ~~f'~+~ ~F' .°~---
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 S18'795
amount of these taxes, and additional penalties, interest, and costs that may
accrue. '
(Rev. Septamber 1978)
Name of Taxpayer
Mildred I Amos
Gemini Transport Permit Services ComQany
Residence p0 Box 606
Fort Pierce, FL 33452
Kind of Tax
(a)
941-01
941-01 '
Place of Filing
Tax Period Ende,d Date ot Assessment
[D) [C)
7909
7912
Clerk~ Circuit Court
St Lucie County
Ft. Pierce, FL 33450
This notice was prepared and signed at
the 25th aayafFebruary ,~g 81
07-21-80
06-16-80'
I
Identiiying Number
(d)
59-1671467
~~
Ft. Pierce, Florida
Ilnnaid BsdAnce
of Assessment
(aJ
2,052.15
518.72
To~a~ s 2, s~o. s~
, on this,
S" e Title '
~'avmond Salver Revenue Officer
(N s: Cart~liu ol oflicer authorized by la~v to ake acknowfedpments !s not sent~s/ to tha validity of Not~c• ol
•rd Tar Li .C.M.28~1~. 195a1,C.9. 125.) ~I~ ~~(~
8(l~7Ke~-'~t7 i~Ab~f~
Part 1- To be kept by recordiny offlce :' Fwm 668 (Rev. 8~78)
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