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I Fe~ bbi U. S. TRfASURY D~ART R. INfEWAI REVEM/E SERVICE hr Q~Nw~ol IA» y R~cd'r~ OI11c+ .
f ~RE~.._as~ CE~TIFlCATE OF R~ 6f ~EDBtAI. TAX ~EN Fi~EO ario RECOROEo
~ DISTRICT T, I.UCtE r,OUt~TY. FLA.
~ ~ 162035 oit 169 Pq 802 ~n;::- -~r?;
; ~ hsrob,, a~t~fy thot os w~iollow~~med ,m~o~r.. 1M ?~q~?~.sma,b of Ssdion 63~5~0,, tsso5o
? Inremol Rrverws Code. hove ~ sotisfisd w;th 1o ths toxes enun+ero/ed below, togetF+sr ~~p p ~
with ail sfalviory oddihons provid~d by ~cYwn 6321~ and that ths lien fw wch taxes and68 ~U~ii1 ~ f~ I•'
~ statutory additiom hos thereby bssn relsosed._Jhs psg~s? off'~ in ths offias6~F~srs notics of ~
~ inte.nol ravww~ tax lien wos filed on I+~ L I 19
7 is herehy •
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i authori~d to moke r?o~ation on his books w sFaw H?~ roleose of said lien, insofor os the li~n i) • t_ :'~l' tt ~
i relotes w tM fdlow~ny taxes. LERK CIRCUIT COURT
NAh1E Of TAXPAYBt
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Rf..~IDENCE OR PIAC~ OF d1151NfSS
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j aq~ ~ T~ UNPAID BALANCE
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(Tax Retvm Fortn No.) PERIOD B~lOEO I~SSBSMB~fi DATE IDENTIFYING NUMBER Of /l5SES51~11EN!
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1~.20 03-~1-~1 oe.r11-67 S9~~S~~ 1.063.~
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jY ST~ IJ3CI1i 00~1~'!'~ TOUL i
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s' Jacksonville Florida
} WITNESS my hand at ~ on this,
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the ? day of ~rch 19 6a
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~ DISTRICT DIREGTOROF IMERN/LL R~VBdUE 8Y ' naturo) T~
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A. J. 0' DONNELL, JR• .12~, rL-~~l~~lf~ s~l Procedures Sectio~
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~NOTE: Certifltcfe of ~osr avNwrized by law to toke edgrt~enn is nof essenNd to ths wlidity of this docKneM. G.CM. 26419 ~.8.
1950-1, 125.) "m' S
PART 3--To b~ used for ncordiog purposes d00K ~ r V PA6f
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