HomeMy WebLinkAbout1382 - - - _ _ _ - • . 1
- U. S. TREASURt DEPARTMENT - INTERNAt REVENUE SERVICE • ~
~-~R~v. ~ov. ~9ai~ CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN
~Formeriy Form 669] (~o b~ us~d to blws~ Tax U~ns vnd~ S~cNon 6325~a), I.RC. ef 1954)
DISTRICT SERIAL NUMBER
J~ILi~~ TL~A OR 128 P e 512 139~t69
1 hereby certify that as to the following-nc~med taxpayer the requirements of Section 63251a1, Internal
Revenue Code of 1954, hove 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 statutory additions
has thereby been released. The proper off'icer in 1he office where notice of internal revenue tox lien
was filed on O~tober 12th , 19~, is hereby authorized to make notation on his books to show
the release of said lien, insofar as the lien relates to the following taxes.
NAME OF TAXPAYER
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7YPE OF TAX At~ PERIOD ASS6SS~AAENi DA7E R~ERENCE NO. AMOUNT OF
al (bl ~ assESSti+Errr
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! 9~t r~?ta~a~ u-~t-i3 c~-~a~-is 99-oi6~t! ~.a~
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9~i rtt~al~~ l~-3L-i~? a~-am-6S ~9-0663~7 94.i~
43-~-bs o?~-~66 94-Ofi6~'l 9S.
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~ PLACE ~f f~UNCa i . . ? . : 'i. V
Si. L'UCIt CUUfJTY.
~ ~ FLORIDA ToTAi s
~ lnoa~t Pi~sM~ ~'l~trlda _ ~
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Jacksomrille, Florida
~ WITNESS my hand at , on this,
~
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the 17th d of ~~h 19 ~
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DISTRICT DIRECfOR OF INTERNAL REVBdUE BY (Si~rwfvn) TITLE
~ Chief, Special
F. S. Schmidt Procedures Section
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(NOTE, C~tificot~ of of1'~nr ovllwrized by law fo taks ockrwwl is not euentiol to ths wlidiry of tNs 2M19, C.1 ~91, 125.)
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600K
PART 3- o b~ used for ncordin9 purpos~s
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