HomeMy WebLinkAbout0784 ~
~ ; . , ,..~f ~ i
.€~,.~;_.~?i~
Form 668 U. 5. TREASI;RY DEPARTMENT - ~hTERNAI REVENUE SERViCE
CERTIFlCATE OF RELEASE OF FEDERAL TAX LIEN 1
~REV. Nov. tsbil I
(Formerly Form 669J ~ (To b~ ua~d fo R~Iwsa Taz ll~ns uad~r S~cHoe 6325~a) 1_R.C. of 1934) I
DISTRICT ~ 5ERlAL NUMBER
~ Jaak~ aavill~? Flar id~ n~ l.r~ 82296 _ I
1 hereby ~ertify that as to the follawing-named taxpayer the requirements af Sectian 63251a1, Interna) ~
W Revenue Cocie of 1954, have been satisfied with respect to the taxes enumerated below, togethe~ with ~
all statutc~ry additions provided by Section 6321; and that the lien for s.~ch taxes and statutory aclditions
has tt~ereby been released. The proper officer in the office where notice of internal revenue tax lien ~
ry was f led on ~ab. L, , 194Q, is hereby authoriz~cl to make notation on his books to show ;
~ the release of said lien, insofar as the lien r~lafes to the foilowing taxes. i
~ NAh1E Of TAXPAYER I
Dw71d 3c Flaianc• d. ~aksr ~
~ RE5IDENCE OR PIACE OP BUSINE55 ~
~
~ i
~~1 AMWNT Of ~
~ 1YPf OF TAX l,Nd PERIOD ASSESSMENT [3ATE REFERENCE NO. ~E~E~ ;
!al ,b~ (d) i
~
IT 19'S8 5-15°99 59 oP 401726 !l~95•~ ~
I ;
. ~ RDE~ I :
~ CJ~~`%; ~N« • EC g00K ~
~ - r=-;. ;
.~:1 I
- " '65 MAY I PM 2: Q Q
: _ ~ . ~
' ; i
ROGER utrftAS. C~E ~
. gT. L CiE COU . I ~
~
- _ _ ~0 ;
~ i
I
i
;
I ~
~
~ ~ ,
- - -1--- - _ ~
= PLACt OF FIUtJ~ '
Ci l+b I'~C I'Oli ~ ti ~'i Obl F'+ j
fit. I~uois ~oun~y TOTAL ~ j~~j.pp j
Fort Pfe rese ~ Flor ids '
I
- _ - - - - - j
WITNESS my hand at_~iank.~nn~illat~lcuc~dt-_ ~ . on thts,
the _ _ day of__ , 19_-_~
~~3~--
DISTr~~CT DiftEC70R OF tNTERNAI REYENUE BY (Signature) T~~}ef ~
~ ~«c~~! Procedures S?ction
I '
(NOTE: Certificoto of off'icer authorized by law to take aclcnowie ts ia not easenti~l to the vc~idify of'th~d~up~ G:C_AA. 24~ 1950-1, 1s5.)
- 3~~OM 11.~ 1~
PART 3- To e used for recAr~ling purposes