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�� � � � �� <br /> � <br />-,�� � . � <br /> ��� <br /> �':_.� ` � � <br /> t ;` � � , � �"' � � � �,�� � <br /> ; ; ; <br /> Form 868 DEPARTfAENT OF TNE TAEASUiIY—iN761NAt AEVENt&-SEAV�CE . . �for Opfionaf Use BY Racoiding OHiee <br /> : tnav,2=�n NOTICE OF fEDERAL 7AX LIEN UHDER INTERNAL REVENUE LANIS /, e� <br /> +. D1ST�iICT SERIAL NUMBER 77 V���3 ! <br /> ' i ' Oztiah 31749 <br /> Purspant to the provisions of Sections 632t, 8322,and 6323 of the lnternal Revenue <br /> ; Code.'notice is<beraby given that there have beert assessed under the Internal Reve- � ' <br /> � nue lews of,the United States againsf ihe following-named taxpayer taxes (including <br /> f interest aod penalties) which after demand for payment thereof remain unpaid, and <br /> { ; that by virtue of the above•mentioned sxatutes the amount ot said taxes. together with <br /> z- penalties, interest, and costs that may accrue in addition thereta is a ti�n in favor of <br /> , :z the United Sta;es upon all property and rights to praperty belonging to said taxpayer. <br /> ; s NAME OF TAXPAYER , ' ' <br /> YJoodrova ?S. Sdelsc�n <br /> # RESIDENCE' <br /> ; 2222 �ellwood , �lnartztaeni; 3 ; <br /> r ; Grand Isl:�..nd, IVek�ras2c� ti�'.�C31 <br /> k .. � � . . � . . � . � . <br /> � . �.. . � � � � :� ��� �UNPAID BALANCE �,. <br /> �KINDOFTAX � TAXPEFIODENDED DATE OFASSESSMENT � .,�IDENTIFYINGNUMBEIi OFASSESSMENT <br /> ����� � � �� lal"� � lb) � Icl � Idl (e1 � . <br /> 94,1 7 2-31-7C� 3-�.'..a-77 �.7-C',,c�c�� �>l.fs'3.19 <br /> � x'�� ���9�a.0 �� �� 12-33.-'76 3-?1-77 � � 47-C�5�7F's5� 2E#.51:. � <br /> t lOLrO 12-3�-75 1.?..-�.�-%� 1.,.`72-4�-o'7C�tr. �iU.23 <br /> �; <br /> ,,; <br /> ,' <br /> t � <br /> i <br /> � <br /> �� . � � � i`�� � � <br /> � <br /> f � ' <br /> } <br /> iPIACE OF FILING <br /> � Rep;ister of De�c�.s <br /> COUTlty pf 13�11. TOTAI $1��2?�Q3 <br /> Y Gx;.nd Isl�'.na, r,te?�ra::k=z �3��07. <br /> i <br /> � '= <br /> � ' WITNESS my hand at" �ranrl _�sl a»ci� �VP,hr��ka _- <br /> , on thie. <br /> � <br /> � <br /> � ehe��th day of <7til� 79� <br /> � <br /> ' SIG A�� TITLE <br /> fi AIichael Ponte R�venue �:fficer <br /> - -�.�INOTE.�Certiticnce�-of�oHieer�author¢ad bµlaw to�ake,acknowletlgments is not esaential ro the validity of Nouoe of Fedarai Taa Uen G.C.M. . . � .. � . ..� � <br /> :'.. .. �� 28419.C.B.4950-1.525.) .. � . . . . . <br /> t PART 1 —To be retained by recording office <br /> � <br /> ... ,, �, . , .. <br /> .,�, a ..,, ,w . ... .. �,_ � <br /> %, ' '. � » .. „� <br /> , . . . �. ... . . . . .„- �.. '� �.,.r. <br /> j . . 1 . . �'" +� �g4 , . <br /> +e�� � t�.� . . �.� .� � :�� . <br /> � ;� �';�9�5.. ��� <br />� �, � � <br />� <br />