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~ /onw 66~' • ~ ~ U. c~ QE~ARTMENT --1NTElNAI tEVft~IJE SERVICE . - ~
~ IREV. NQV. 1961) C~~~ ~ ~g~~ ~ ~ T~ _ - .
(Form~rir Fam 669~ ~ fT~ M w~d 1~ ~~New f~ LMw~ w~i~t~~ 6~2S1~l. I.~C. d 1951! -
~ DISTRICT , ' - ' ~ p_~. ,~L NINMlER _ ,
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~ 1 hereby ceitify that as to the follow;ng-twmed taxpayer the ~equireinent3 of Section 63251a1, lrrtemal
i Revenue Cod~:of 1954, hdve been satisfied with respect to the taxes enumerated below, together with
~ ail statutory additions provided by Section 6321; and that-the lien for stich f~xes and statutory additions
has thereby 6een ~eleased. The proper oflioe~ in the office where nofice of intemal revenue tax lien
~ was filed on s--- ~r. 2~, 1965 , 1 q
, is hereby autho~ized to make.- notation on.=his books to show
~ the release of said lien, insofar as the .lien relates to the folbwiny taxes.
( NAME Of TAXPA : 'as:'. . t_,_
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~ RESIDBJCE OR CE Of ~ - - .
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F TYPE OF TAX At~ PERIOO .'~ASS~6IMEM-WITE REFEREIrCE NO.
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WITNESS my hand at Jackeo~ille, Florida - , on this,
rhe lbth d~ of Dece4ber 19 66
o~sr~ucr a~croe of i~t~ ~v~ ett t~nj Trr~
F. Sot~idt Chiel~ Specl~al.
Procedures Sectioo
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(NOTEs G+tificoh of oA'~ outhoriwd by low to tak~ y not ~ssenfiol b th~ wliduy of this documnf. G.CJY1_ 2b119, C.6. 1950-1,
PART 3- us~d for ncordinq purpos~s 0 R
SOUI(~V~, P~rE
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