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Ferm 668 U. 5. TREASURY DCFARrl.1[NT - INTERNAL REVE`.UE SECViCE r ~t
IREV. NOV. 1961) i CERTIFICATE CIF RELEASE dF FEDERAL TAB(. i.tEt~
(Formerly Form 6691 ITe FN w.d to R.Iwss Tox Lbnt u,~).r S.cllon ~JZSIa). L~.C of 1 5~1~ ~'• .I I ~ ~ ~ R
DISIRICT~y~~~ ~~/~~y--pp~~ SERIAL Nu~,i1_AyE.R •~
_~TA_Ylli~.;~i8~_ ----- ---------------~0.~. )600 ~1~ ~~Jw
I hereby certify that as to the following-named taxpayer the requirements of Section 6~251a1, Internal
Revenue Code of 1954, have been satisfied with respect to the taxes enumerated below, together with
all statutory additions provided by Section 6321; and that the lien for such taxes and sta~utory additions
{Tas thereby been released. The proper officer in the office where notice of internal revenue tax lien
was f led on-.__-_~~~ -, 19~, is hereby authorized to make notation on his books to show
t{Te release of said lien insofa- as the lien relates to the `ollowing taxes.
NA:VSE OF TAXPAYER
s. s. & s. s~ gills __-- - .
RESIDENCE OR PLACE OF BUSINESS
608 )ara-ok Roads )lrort Piorco, Florida - - - - __-- -- -- -
TYPE OF TAX SAND PERIOD
lal
10~F0 IaooM 1961
ASSESSMENT DATE
Ib1
5-18-6E
REFERENCE NO.
Icl
i
S9 232079731
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- .. ~ " . ~IIED AND R CORDED ~ I
BOQK
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- - -1N __G~f ui~. _
- ` :. ~~ 1962 NO'S 20 AM 10: 10
ROGER P01
LUCIE CDU
$T RA FrIG IDA 1~
~,
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PLACE OF FILING
Cl~rlc~ Ciratiit Court
3t. La~• coaat~
tort Pioroe~ )Florida - -
WITNESS my hand at Yet Palas<_~h~-41~.i4~ ___
the ~~F_L,h-day of xor~i2~r 19 _~_
on this,
DISTRICT DIRECTOR OF INTERNAL REVENUE rBY ( nature) TITLE
LAURIE ii. ToltLt~tBON i ~ ~ ~~~ ~ , Collsotioa Man,ag+~r
INOTEr Certificct• o} ot'icer authorized by law to take ocknowledgmenrs is not essential to th• validity of :hi>l r,ocument. G.C.N.. 26319, C.B. 1950-1, 125.)
AAIOUNT Of
ASSESSMENT
Idl
= 68.83
i
TOTAL S Nb8.83
PART 3 - To be used for recording purposes