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' Feew 664 U. S. TREA$~1RV OEPAI2TMEHT - INTERNAI REyENUE iERVKE Far qp:wl Uai Br R«r~+q OH:ce
~ (REV. 8~67) • CERTlFItATE Of REIEASE OF F~ERAt TAX lIEN =
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~ DISTRICT SERIAL NO. 1~~-. '
I J , FIt,ED ~AND' ~RECOROEQ
' , ST, LUCI~ C~IUNTY, FLA.
( I h~r~by cKtify thot os to tM followins-~am~-~xpry~r th~ nquiroai~ts of S.cr~«, - :l•_~~~~ yF~~FlED
~ 6325(a), _Int~rnol R~wnw tod~, how b~M sdt~fi~d with ~~spsct w iM tox~a ~o~- ~
i n+~roted b~low, toy~fh~r with oll statutorj~ additions ,povid~d by Seetion 6341; e~
( that th~ lian (w svch tozos ond stotuto~r odditions hos tl~inby b~~n nl~os~d. TI~ pu
I prop~r oHic~r i` ~ offic1 wh~n eotie of inti.na! rev~nw tox lien was fii~d on 9 OrT 9 fPi Z. 32
v , 1~~ is Mnb
y authori:ed to wek• nororidK
on 6is books to show the r~leose of soid li~n, inso(or os th~ li~n nkt~s to thi ~ C
foilo.~n~~rox.s. : :f~{3~F:~2 -AOFTRA~
~ NAME OF TAXPAYER ~ ~ CL~RK ~{RCUi~' COURT
~ rsa~ i.oc~s " ~ .
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~ RESIOENCE ' - ~
+ ~~l~ ~N~ - _ . :
~ C~ASS OF TAX ~ ,:UNPAI~ BALANCE
~ (Tox R~twn For~No.1 PERIOD EN~ED ASSESSMENT DATE' = IDENTIRYINGNUMBER ~ OF ASSESSMENT
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~ ' PLACE OF FIL~NG ~ ~ '
~ i ~ TOTAI s
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WfTNE55 my hand at ~~a , on this,.
the T dq o~~~r ,19 ~
SIGNA7URE TITIE
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(KOTE: Cutificet~ ef offiesr wthari:~d br low 1e tak~ acknowled~~nts is rat ~sseMiol te N» validitp of Hdic~ ef F~ol Tau Li G.CJ1/.
~~9, c.s. ~9so-s~, izs.~
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PART 3-To b~ us~d for ncordin~ pue~o~
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