HomeMy WebLinkAbout0435 ~ Ferm 66~ U.•S. TREASURY OEPARTI~IENT - ~NTErtNai REVEHUE SEttv~CE Fa OM~a»I Use er Reco.d.M OH+c~
iREV.B&~~1~ CERTIFICATE OF RELEASE OF FEDERAI TAX IIEN
' DISTRICT SERIAI NO. i7H~62 F1LE~ AND RECqttp~O~_
; J~p~~ r~~ ST, I.UCtE COUNTY,~RLA:'
1 hereby c~rtify thot as to the following-nomed toxpoyer ths reQuirements of Section ~~CORD VERIFIEO
6325(0), Inttrnal Rsvenue Code, hove b~~n sotisfied witF~ respecr fo the toxss enu- ~pVOJ /
meroted belew, togsther witF~ oll statutay additions provided by Section 6321; ond
p~ •
thot ths lien fw such toxes ond statutory addie ans has thereby been releas~d. The ~ r!1 ~Z
' proper officer in th4 office where ~otice o~~rternol revenue tox (ien wos (iled on
.111D@ L , 19 ~s hereby outhorized to moke natotion ~~Z~~
on his books to show the releose of soid lien, irtsofor os the lien relates to the RQGER POtTRAS
followin9 toxes. CLERK Ci{RC.V~T CiDURT~
~lAME OF TAXPAYER
J~1 ~ DO!'0~.~ D~~
RESIOENCE
~qp~ ltidpt~a~a lt+oad, ~ost K~~a, !'la~rl+it ~34'!D
CLASS OF TAX UNPAID BALANCE
;Taz Return Form No.) PERIOD ENQED i"~ESSMENT DATE I~• lFYING NUMBER OF ASSESSMENT
~o? ~b ) t~ } ~d ) (e )
lo~o ~/3~/6T 7~5-l~ zb5-~o3-obs,3 _ 1,SS~.95 - -
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~ PLACE OF FILING
~~1 ~ ~ TOTAL S
~ Str~ Litie~~ Cwa~ ~SS~•~
~ Mfre~~ T2Ari~da
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~ WITNESS my hond ot lacksonville., F~otida , on this,.
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~ the_1$tli_dcy of November ,19 69.
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~ SIGNATURE TITLE
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~ ack Duraat Chief S ecial Procedures Sectior~
~ (NOTE: C~rti(icot~ of offic~r ovthori:~d by Iow to toke eckoowl~dyn+~nts is not ~ss~Miol to the di ~c~ ef F~d Tos 1~~~ G.C.M.
~ 26.119, C.B. 195P51. 125.) 6~~~~ ~r~t~~
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- PART 3--To be used for recording purposes
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