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~ ~ F.7fm GGS ~ OEPARTMENT OF THE TREASUitY-1NTERNAI REVENVE SERVICE Fot Opticx~ol Use By Rtcottfing O~ct
~ • (REV. 10-71) NOTICE Of FEDERAI fAX UEN UNDER INTERNAL REVENUE LAWS ''t
, ; DISTRl~T SE~IAL NUMBER ~T.~~pA~ ~~~~Y -
, - , JACKS~NVILLE = i~OER PO~TAA~ i
~ . ~~'~,~R~1 1ii1'?G IT CCU~T ~ t
Purs~ant to the provisi~ns of Sections 6321, 6322, and 6323 of the Internal Reve- RR4~0 V[~IFI~~ 4 ~
~ nue Code, notice is hereby given that there have been assessed under the Internal ~ ~ j~
Re~enue laws of the United Stotes QgainsF ihe following-named taxpayer, taxes (includ- ji ~ -
ing interest and penalties) which after demand for payment thereof remain unpuid, and =
that by virtue of the above-mentioned statutes the amount of said taxes, together with
s penalties, interest, and costs thot may accrue in addition thereto, is o lien in favor of ~ - 3
_ the United Stales upon al! property and rights to property bElor.fling tc said taxpayer. ;
~ NAME OF TAXPAYER . . ~
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~ BBASLBY ~LTON S• - . .r
- ~ S
~ ~ RESIDENCE _ ~
; ; 500 Soath-Indian River Drive - ~ ?
s 201 S 2nd St. Ft. Pierce, FL 33452 ~ _
~ , UNPAID BALANCE i
KIND OF TAX TAX PERiOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
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~ - 941 03•31•7S _6-2-75. 59-1110032 1,613.72 ~ ~
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PLACE GF FILING CLERK, CIRCUIT COURT - -
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F ST. LUCIE COUNTY - TOTAL ~ ~
~ _ FORT PIERCE, FLORIDA - - _ 1,613.72 .
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£ WITNESS my hand at West Pala Beach, FL ?
s _ , on this, ;
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~ the lOth - do of June 19 75 _ - -
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J 8. Bruin Gzo~r . ~
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; - (N . Certificote of of~icer avthoraed by faw to take acknowledgments is not essential to the validity of Notice of federol Tax Lien G.C.M. ;
264 9, C.B. 1950-51. 125.) ~ 0 R ~~"]~1A 3
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- PART 1-To be retained by retording office $OOK i
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