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Form C~Gg OEPARTMENi OF iME TREASUAY•-WTECNAt RtVfNi;_ x2VSCE Far Opt;onat Use By Rc~rord;r.g Office -
(REV. '-70) NOTiCE OF FEDERAI TAX LiEN UNDER lN?ERNAL REVENIlE LAlIVS t~l1~v ~~s~ ~E;;r~~?IED ~
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DISTRICT SERIAL NUMBER ~t.~.~JS'[- ~N;JliTt' f~t.
ftG~c - :~~'A!S . v.
Jr1CKSOt3VILLE - CIERK i•: ~~slt ~GURT~fi ~
Pursuant to the prov~sions of Sections 6321, 6322, and 6323 of the Internal Reve- 4Fr~ f~°"'~'~~ ~
nue Code, notice is hereby given thot there have been assessed under the Inlernal y ~ ~
Revenue laws of the United Stotes against the following-named taxpayer, toxes (includ- ~tA~ ~ IL o3 PM 7~
ing interest and penalties~ which oRe~ demand for payment thereof r~main unpaid, and
- that by virtue of lhe abov~mentioned statutes the amount of said toxes, together wilh -
penolties, interest, and costs that may accri~s i~ addilion theret~, is a lien in favor of
the Uniled States upon all propery and righh~to p~ooerty betongi~~g to said taxpayer.
NAME OF TAXPAYER ~
Jameo Bert Ooley -
~ J B Doley YaintinQ :
RESIDENCE YU Box 1712
_ Ft. Pierce, FL 33452
~ - - UNPAID BAIANCE
KlND OF TAX TAX PERIOD EN~JED ASSESSMENT DAt~ IDENTlFYING NUMBER OF ASSESSMENT
(a) (b) l~~ Id) Ie)
941 12-31~72 02~24-75 _ ~9-1028795 $154.97 -
- - 441 - ` - 03 -31-73 - 02 -n3 -75 59 -10287'~5 " $168.08 - -
941 06-30-73 02-03-75 . 59,1028795 ~ $ 84:14 - _
941 09-30~~3 02-~03-75 59-1028795 51~1.06 ~
. 941 I2-31-7~ 02-03~-75 - 59~1028795 . $157.56
94U 12-31-73 02-03•75 59-1028795 ~~137.68
941 . 03 -31-74- 02 ~3 -7S 59 •1028795 $ i54.08 .
941 - 06~30~74 02-03-75 5y-1028795 $1~?5,73 -
941 09-30-74 G3^17-75 59~-1028795 $171.54 -
940 12 -31-74 ~2 -24 -75 59 -1028795 ~ 86. 63 - -
PLACE OF FIIiNG _ ~
~ilAtfR~ ~ilfCUtt t:OUrt
S~ LUClO ~ CAURh/ ~ _ TOTAI $ 14 )1.4 7_
Fort Pterce, Flortcle =
WITNES.S my hand at j~:~ami, Florida _ _ , on this,
- - s00K~.Jc~ -PAGF ~ - _ _ - !
rhe 30th day of APril , 19_ 75
SIGNATU2~ - ~ITLE - -
- ? ~ Chief, Office Branch
i • v c.'c.~`' - -
(N~1E: Certificot~ oF officer avthorize y rnH fo take acknow!ec~3ment> is no1 essential to the vaLdity of Notice of Federal Tax Lie~ G.C..tit.
264 s y, C.6. 195a-51, 125. ) - - _
PART 1-To be retained by racurding ofiice -