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Form 668 Department of the Treasury - Internal Revenue Service
(Rev.Septembert978) Notice of Federal Tax Lien Under internal Revenue Laws
~IS1fICt Serial Number Fw Optlona/ Uss Dy itecorwng Ot-/cs
Jacksonville~ FL S~vp•rJ I~I Ff6 13 IIN s~ 0~
Fil[,o ~+c ~~ca-a o
As provided by sections 6321, 6322. and 6323 of the intemal Revenue Code. ST.[~~~• COUNTY.FLA.
notice is yiven that taxes (includin~ interest and penatties) have been assessed ROGE~ POITRnS
agains# the following-named taxpayer. Oemand for payment of this liability has CIERK C~tCUiT c4URi
been made. but it remains unpaid. Theref~re, there is a lien in favor of the United ~Ft~~P~ `'~~P'~ '" ~--
States on all property and rights to property betonging to this taxpayer for the
amount of these taxes, and additional penalties. interest. and costs that may ~~`,~s
accrue. vV /
Name of Taxpayer ' -
Koley Inc a corporation
,
Prescription Ccnter _
Residence 1223 Delaware Ave ~ • .
Ft Pierce, FL 33452 ~
Unpsld Balance
Klnd of Tax Tsx Period Ended Dste of As~essment Ida~tifying Number of Assessment
[a) [b) fc) fd) f~)
941-01 7806 08-04-80 59-1430306 - 1,709.53
940-10 7812 07-02-79 " 57.99
940-10 7912 06-23-80 " 65.21
Place of Filing Clerk, Circuit Court ~•
St Lucie County T~~
~ _
Ft P;erce, FL 33450 1,832.73
This notice was prepared and signed at C.1: Pierce, Florida
, on this,
t~ 3rd ~yof February .1~ 81
S' e Title
- ond Salyer Revenue Officer
~ W~: C ifiuts o1 icei eufAwized Dy few to f~ks acknowlWymants !s nof osaontN/ to tM validlty W Notic~ ol
sde~~l T~~ Lie~ O. ._ 28,19. /~50~1. C.6. 1P5.) (1~~~ ~~VCi~~
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Part 1-- To be kept b~l recordiny oHic~`, Form 688 (Rev. 9-78)
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