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Fo~m 66~ i Department of tAe Treasury - IMernal Reve~ue Serv~ce
~ Notice of Federal Tax Lien Under tnternai Revenue Laws
(Rev. September 1~7is;~
- - --------~ -------- ------- -- ----
~IS~fICi TSeriai Number ~~ ~or Opt'ona/ Uso by Reccrd~n~ J~r.ce ••
_ ~Jaczsonville, r1a. ~ _ _ ~ ~
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As provided by sections 6321, 6322, and 6323 of the Inte~nal, Revenue Code, ~ S1.~~CsF C~'~~:y; +'•f ~~•
notice is given that taxes tinctuding interest and penalties) have been assessed ~ f~CGf.R f'Cf1F'~-=' ~
~ CLEi~HC:"fU:- ~{~.;Fi
against the follo~vmg-named taxpayer. Demand for payment of this liability has ~ q
been made, but it remains unpaid. ThereforQ, there is a lien in favor of the United ~' ^~ i`~~. O~
States on aSt property and rights to property belonging to this taxpayer for the i
amount of these taxes, and additional penalties, interest, and costs that may ~ _~ „~ _ 6^
accrue. • ~ i~l
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Name of Taxpaysr 1
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r'ran::~ in C. ~lar~ ~
-- .~a r.'tt ,'~: "t.l a ~, ~ ^ I}z ~. ~1a ~ 1 ~
Resid2nce ~
31oI S.E. Ja~~ st.
~t~lart, r la . 3~~:9Lt ~
Unpaid Balance
Kind of Tax Tax Period ET~ed Date ot Assessment , Identifying Number of Assessment
ra~ rn~ rw I rd~ te~
°41 Ol 4005 -- --2-23-~1 ~~ ~9-1;7~~70 -- -- 10~[71.~'2
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Place of Filing ~ ~:;rit oi ~i;e ~%ircui ~ Gourt ~ ~
St. Lucle ::~~~.::~ty ~
33~50 Total ; t 10, 771.~2
r t. Yierce, :'~.a.
:Fest : ~ ~_ ~eac?. r1C ~
This noti~e was prepared and signed at _________-_' ~_` _____'____ _______-___ -____ _. on this.
the_~%r_- _ dayof ;=arc1~ _ ,~9 ~1
Signature
Title
::. '~~. ~artc~r L~ . l,; ~~.~- i y.eve~~:~:a Jl~icer
(Note: Cert~t,cate ol ol;icer suihunzod by !aw fo fake ecknowleOgments ~s not essenUa/ fo tho vali~ity of Nutrco of
FoderN 7ax Uen G.C.M. ?6~19. /9541, C.B. 125 ) ~(~f(
Bp7it ~~ PIGE ~~1
Pa~t 1- To be kept by recordiny oft~ce• Form 668 (Rev. 9~78)