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~ ' i U' TREASURY DEPARTMENT • tNiEPraA! eEVENVE SFRVic_E ' '
r Fa~ eee ~
~ ~REV. NOV. 1961) ~ CERTIFlCATE OF REIEASE OF FEDERAL TAX LIEN
~ r'~ (Formerly Form 669} lTo b~ used lo R~leose Tax liens undw S~cfio~ 634SIol, I.R.C. of 19541
M DISTRICT SERIAL IVUMBER
~ TFlorida F'~~~ 131001. _
' 1 hereby certify that as to the foilowingnamed iraxpayer the requirements of Sectian 6325(at, intemal
Revenue Code of 1454, have been satisfled with respect ta th~ taxes enumer~ted belaw, together with
a11 statutory additions provided by Section 6321; and that the lien for such taxes and statutory additions
has thereby been released. The proper offiter in the office where notice of internal revenue tax lien ~
? C~ was filed ~n~'ovember 27th , 19~'i1~, is hereby authnrized to make notation an his books to show i
i the release of said lien, insofar as the lien relates to the following toxes. +
~ NAME OF TAXPAYER '
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4 RESIDENCE OR PIACE OF BUSINESS ~
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( fnMOUNT Of
~ TYPE OF TAX AND PERIO(7 laSSESSMEM DATE ~ REfERENCE NO. I I
do? , 1b} I i ASSE'SSMENT
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PLACE Of fILING
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V1~l7NES5 my hand at__ ~'~cksorv'~~ ~'lo~ida , on this,
the 2'~th day of ~cr.nhPr , 19_~~
UISTRICT DIRECTOR Of IIYTERNAL REVENUE 8Y (5igrwtvre) ~ TI7LE ~
Chief, Special
rroceciures Section
F S S
INOTE: Certifieot~ of offkar outhoriud by faw to take «know h is not ssaeretial to ths validiry of rhia deeurr~t. G.C.M. 26419, C.B. 1950•1, 123.)
PART 3- e u:ed for r~tordi~ purpases g00K ~