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Feet 66S U. S. TREASURY I>EPARTMENT - INTERttAI REVENUE SERVICE
' (REV. s.6~) CERTIi1CATE OF RELEASE OF FEpERAt TAX t~N-
DISTRICT SERIAL,;I~O.
Afl!!is ~7132~5 x-173 P-2959-
1. hereby certify that os to tM following-named toxfisyer tM rpvirements of Section
63Z5(o), Interpol Rewnw Code, how been sotisfiia with nspeet to tM foxes •nu-
meroted below,.to9ether with all statutory additions`povided by Section 6321; and
that the lien for such foxes and statutory addition:-has tMnby been released. TM
~ paper officer in the o(fiu when notice of interrtel ~rwenw fox lien was filed an
,_ACteb~,r 16~ , iq ~- is hereby authori:ed to woke norotion
on his books fo show the release of sold lien, inso_for es tM lien relates to.the
followirt~ foxes'.
i ,.
~ NAME OF TAXPAYER
~ ~ ~1
RESIDENCE
i
3f~ ~p
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Fr O,riO~l tb~ B, Reewd+! ~~
FIlEO ANO RECORDED
ST. ~EUCORD VER ~YEDLA.
183,243
'69 SEP; i 9 PM f2 : 16
nQDER :-OITP.i>S
CLERK CIRCIltT COURT
CLASS OF TAX UNPAID BALANCE
(Tax Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o) (b) (c) (d) (e)
PLACE OF FILING
TQTAL I f ~~e~
WITNESS my hoed of Jackwmrille, l~lorida , on this,
the i8tb ~y of 8epteeber ~ 69
URE TITLE
~~>~t
Vesfsoo UWit} cting Chief, 8pscial Procedures Sectioa
(NOTE: Certificate of officer outheri:ed by low to take eeknewledp~ents is not essential to tM validity of Ndiee of Federal Ta: Lien G.C.M.
261,9, C.B. 195fYS1, 125.) ~ R 119 X2940 p''
aoaK
PART 3-To be usfid for recordtnR puepose: