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Fo.~ 668 U. S. TREASURY DEPART6AENT - INTERNAL REVEHUE SERVtCE Fp QDf~Orql Uit BJ RKO/d,~ a+.~.
' fREV, &67) CERTIFICATE OF REIEASE Of iEDERAI TAX llEN
DIST~ICT SERIAI NO. O6
~~~~a FI ED AND REC~SROE~'
1 hereby eertify tho~ os to the following-nom~d toxpoyer the requirem~nts o( Secti . LUCIE COUNTY. F(.A.~
6325(a), Internal Revenue Code, Fwvt be~n sotisfied with respect to the toxes enu- E.CQR'J VERIFIED
meroted b~lo«, together with oll statutory additions provided by Section 6321; ond ~QCQn~
that the lien for such to:es ond statutwy odditians hos thereby been ?eleosed. The D~~OJ
prope~ officer in the office where notice of internol revenue tox (ien was files N ' 9 PM 2• 2
Q tember 12 •
, Q , 19 69_ is hereby outhorized to moke nototion
on his oooKS to show the releose of soid lien, insoFor os.the lien relotes to tha ~~.~.~,G~
following toxes. tOvEP, ~-0lTf~~
NAME OF TAXPAYER ~=I~ ~ CL RK CtRCUIT COURT<
1 ~ •
RESIDENCE ~LM ~•a~ ~ ~
~f~ f
10l~ ~Lt~~ ~I~ei~~31~~
' CI.ASS OF TAX UNPAID BALANCE
(Tox Return Form No.) PERIOD ENDED ASSESSMENT UATE IDENTIFYING NUMBER OF ASSESSMENT
~ ~o) ~b) ~c) - id) (e)
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I
9~ 3-3~! 7-~-6! S!-i~lio5a 500.~
PLACE OF FILING C~it ~Y:„e
s~ TOTAL S
~'~i .~~lM~ ~'S~
~'dITNESS my hand ot Jacksanville~ Flnr~da , on this,
~h e 17 th doy of Novamber ,19 - b9 _
51GNATURE ITLE
~ ~ Chief, S ecial Procedures Section
~ (NOTE: Ce.t~Fic of oific~r outhorized br low ~o toke ocknowledyments ~s not essentiol to tF» valid~ty of Noric• of Federal Ta: Lien G.C.M.
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~ PART 3-To be used for recording purposes
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