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.~;. C A J. -" AI ~ ,M.!' C:-~
..~.. u. s. 1IIIA&IIW 1BtM1lBT. l.nlU" alYlllU1 MtIYICC
. t.lJC![ COUNTY. rl6l.TfPlCATI-OFIILIAII 011 PiMIAL TAl LlIM ---
UNDER INTERNAL. REVENUE LAWS .
o .. ...Il 10' ...... r, , .s.~ '".
NO.
Jacksonville Florida Book 9 page 61
I hereby certify that c:a to the followJnQ-nc:med taxpay. the NCJl1remmta of s.cuon 632S{a), Internal Revenue
Code of 1$4. have been satisfied with respect to the taxea enumerated below~ tooetMr with all statutory cddlt10na
provided by Section 6321; c:md that the tien for aim tClXlle c:md statutory cddlUona haa thereby been released. The
proper officer In the office where nctice of Internal revenue tax l1en W~ fUed on October 12 , 19~,
is hereby <lJthcdzed '0 malte notation on his books to show the release Of sald l1en, 1naofar c:a the l1en relates to
the followinQ taxes.
P... '" '
"It". "'''N ,...
N.... 0" T..X....ylr"
~inthr~p Inp,erso11, t/s Shirley's Restau~~nl
IIEI.DtlNCE OR "LACE 0.. .,1.."
Rt. 2 Box 3LO L'ort Pierce Florida
NA TUR. ()It TAX
ACCOU"T 110.
V.AR 011 TAXA.L.
... 11100
AU I"'" NT 1)AT.
AMOUNT 0..
AS.........T
Withholding
9O-S-16723l
6o-8-1662S1
J\ddl 12/31/ 9
3/31/60
6/30/ffi
6-2L-ffi
5-21-60
8-l9-&J .
s
Withholding
Withholding
ffi-6-290620
LO.3S
3,012.66
2,L91.11
!~~:'7~5
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.....
. .
.- .,
". , ~
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~.. I . . . ., .
TOTAL
s 6,OOL.78
Tn. CLm. CIRC!~IT :!': HT
51. LUCIE crC:1TY
FORT ~H3Ci, :-'LrRIDA
WITNESS my hand at
the 19th.
Jacksonville, Florida
, 00 this,
day of
July
19 61
,-
Laurie .(;. To'Tllinson
TITLE
r:.1!~. ~:,,,~l"ll
DISTIIICT DIIIECTOII 0" INTEI\NAL liE VENUE
. t :::. ..:'t:L.1 .0,:; ~~,'. :t.Jil
ag
(NOTE: Certificate of officer au.hOTi
G.C.M. 26419, C.B. 19~1. 125.)
tolte ocltnowledqment. i. not ___1101 to the v;JUdlly of thie document.
o. .. OO'I'DJlMan P'aDITDIO CN....E: I.... 0 - "'.'.1