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(T ! "rr ,". ~y~' l TREA!l.JRV O€PAAlloIOIT . 'NTUNAL UVUlUI UIlVllI
.~ '~.;:J:'~'.:,~ -~'~! :te*ftflCAT! Of RELEASE OF fEDERAL TAX LIEN
UNDER INTE!RNAL REVENUE LAWS
To be .....~ 10 R.l.cu. Tos U.... /JAJ.r Sec',01I 6J:J II
T ,.0.
Jacksonville, Florida Book 8 page 93
I hereby certify that as te. the followinQ-ncrned taxpayer the ~1rements of &-<:"'tlon 6325(0), Internal Revenue
Cude of 1SS4, have been saUrlied with respect to the taxes enumerated below, tOQether with all statutory crld1tions
prov1ded by Sect10n 6321; a;1d that the Ilen for such taxes and statutory crlditioos has thereby been released. The
proper officer 1n the office where nctlce of internal revenue tax Uen was filed on T1A~? -, 19~.
Is hereby wthcrlzed to make notation on his books to show the release of !iold Uen, 1nsofar as the Uen relates to
the followln<;J taxes.
Form 669
lIlav. JAM "M
HA.... 01' TAX"A"."
~':illial'1 B. iL Vergie L. Peterson
".iIO.HC. 0IIl "LAC. 01' BUIIH."
'Route 2 Box Tiprt Plaree Florida
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NATUIU!: 0' TAX
ACCOUNT NO.
YEAR Oft TAXABLe:
I"E"IOO
ASlESS,"HT DATe:
AMOUNT 01'
ASSI!:UMI!: ICT
$
IT
58 D 26285-8
19 6
13-2 -S8-
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11
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TOTAL I 442.~ 2
''"J: \,r 1<: '!-~, CR' 11,1' CO H T
Sf. L'lCIE co:mrr
~GRT PJERCZ, ?LORTDA
WITNESS my hand at
2J st
'JACKSONVIllE, FLORIDA
, a1 this,
the
day of
November
19~
CerUf1=tll of officer authorized by law ..?/'"
G,C,I.A. 26419, C,8, 1950-1, 125.)
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OIITIIlICT OIRI!CTOR 01' IMTl!lIlNAl. RI!Vl!!HUl!!
; ~:-
Laurie Vl.:'omlinson
(~'rE:
II aclcnowled~ment. III not 01l"on1101 to tho va !dlly of thl" document.
t s OOV%,MWUIT nt!'(TL....... OJ'J'lCE: IH4 u. HHI'
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