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U. S. TREASURY DEPARTMENT - INTERNAL REVENUE SERVICE T
Farm 6°° - C~RTIFiCATE OF RELEASE OF FEDERAL TAX ~IElrl~~~ If ~ ~.~~ `~ ' 11•
(REV. NOV. 1961) (To ba u-ad fo Rdaaia Tax U•m unslar Sactlon A3251at, LR.C. of 19S~t
(Formerly Foyn 669) ~~ __
SERIAL NUMDER
DISTRICT
_ _ __ Ja_ckson~rille, Florida Book 8 Pa . a 133 - ~3u __
I hereby certify that as to the following-named taxpayer tho requirements of Section 63251a1, Internal
Revenue Code of 1954, have beer. satisfied with resFect to the taxes enumerated below, together with
all statutory additions pro:~ided by Section 6321; and that the lien for such taxes and statutory additions
has thereby been released. The proper officer in the office where notice of internal revenue tax lien
was filed on_ Februa nth 19 ~ is hereby authorized to make notation on his books to show
the release of said lien, insofar as the lien relates tc the following tuxes.
NAME OF TAXPAYtR
_ ____ Otie F. a__L_~a _A. Kelley --------- --- - -- - - --
RESIDENCE OR PLACE Gf BUSINESS
Casa Ca rona A artTnenta Fort Pierce Florida
REFERENCE NO. AMOUNT OF
TYFE OF TAX AND PERIOD ASSESSMENT GATE ~ AS,;ESSMFNT
Inl Ibl Ic) ~ Idl
I; 1958
. _
._ - :,.
,,,: .I
- }
5-22-59
-. _~~----------_ 1_ -_ _-------- --
I
59 oP 405165 i 380.12
~~'
~~O~1S
IN~clal- ecoC~R~~COK
1962 NOV I AM R: 44
ROGER PO TRAS, CLERK
ST. LUCIE CO NTT, FLO(~18~
D ~ ~L
_f~ ~1
PLACE OF FILING
Clerk oP the circuit Court
St. Lucie County
Fort PierceR Florida
WITNESS rrly hand at
the _ 8th _day of
Jacksonvill®~ _Florida
-- - ------- I
i
TOTAL 2
--1-
380.12
on this,
November tq 6^c
DISTRICT DIRECTOR iUF IN(ERNAL REVEflUE
w Laurie ~ Totalinaon
INJTE, Certifiwt• of offr_er ovthorizad by lay
BY ISlynotun) ~ TI1LE
('~ i _ .
1~ t~ ~ /~1 t ~ ~ - - Froccdt,rc:~ ,;~~cr .~~,
take ackn~dgment~ It rat e~scntial to the validity of thb doc~nunt. GCM. 20A ~ 9, C.B. T 950- I , I YS.)
PlaP.T 3 - Te i~• u~sd for rscarrliit~ nvmos:s _
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