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~ he~ 66~ ~ U. S. TREA54JiCY D~ARTMBJ~ . INTERNAI tEVEtil1E SERVICE . - , hr 4Nw1 !M 4 R~c«1W OIIta
I ~r~v...as~ CERTIfICJITE OF REtFJISE OF FEDERILL TAX UEN ~ .
p,~i~ y FILED ANO RECORD~D!
~ t'1~. O~ 190 P• 469 ST. FU~C~E' O U~! Y~ ~LA.
1 hereby osrtify that as to ths followirg-nom~d foxpayer ths req~iremenh of Swion 6325(a), ~
i Internol Revaws Cods, haw been wtisfied with rpp~ci to the roxes enumerated bslow, togetMr ~~i~~`-~~ C.L~-
~ with oll sfat~tory oddiNons provided by Ssction 6321; and thct the lien for wd~ tmces a~d !sa ~ I 5 I: 36 ~
staturory odditions has thereby been releosed. iM proper officer in the offio~ wh~ro notice oi C .l~ _
~ )nterr?al nvsnw tmt Ibn wcs filed a1 ~OV~eI iZ~ ~q 65 y M~ ~~a)~a~`t
ovthorized M moks rwtation o~ his boob b tF1ow fhs roleoss of scid lien, fnsofar os ths li~n r %iUi~' t`U'T IZ~.$
~ relates to ih~ followinp toxes. CLERK CfRCU1T COURT
i NAME OF T/1XPAY6t
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i R6IDETICE OR PLACE Of 6USINE56
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~ a/1~ pp TN( UNPAID BALANCE
~ (Ta~c Rsltxn Fortn Na) PHtl00 BrD[a ASU35~AA~1i QA7E IDBJTIF1fING NUMBER Of ASSF55MB~R
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I ! 1~0 1!n],/b~ ~3-45 266-~r66T~ 13j.~t
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I i Lt~1~A L~I~/~? S-~l-65 l66-~~r~ T~3.L~
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~ i Pu?cE of Aur~ C~~ arst~is oNrt
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~ Jacksonville, Florida
WITNESS my hand at , on this,
F~
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~e llth ~~of Marc6 t9 68
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~u DISTRICf DIR6(.TOR Of IMEiNIAL R~VB~UE BY {Siy~wrirr~ TITIE ,
~ A. J. O~Donnell, Jr. ~
ce,..~ ~
~/l Special Pro
QJORE, GMflooh of offiar avrl~oriz~d by law fo tak~ ~dprnsnts b not ~sssntid to th~ wlldity of this doa~mrK. G.CM. 46419. G9.
~vso•i, ~~s.~ 0 R 1! U ~~~5 tPP
~ BOOK FAGf
~ART 3-To be used f~or ncording purposes
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