HomeMy WebLinkAbout2974 ~
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form 868 I - U. S. TREASUkY DEPARTf.1Fn;i - INTERNAL REVENUE SFRViCE
(REV. NOV_ 1961) 1 1S`~`~ CERTIFICATE OF RELEASE OF FEDEitAI TAX LIEN
(formerly Form e19? ~ ~To b~ ustd b Releas~ Ta: Liens und~r S~ction 6325(a), I.R.C. ef 1954)
' DISTRICT ' SERIAL NUM6ER
~j JAtiSG~iIfILii. ?~O~TDA I 111473
f t Sect- ~~63Z~C P erna
~ I hereby certify that as to the .ollowing-named taxpayer the requirements o ion al, Q
Revenue Code of 1954, have beeri satisfied with respect to the taxes enumerated below, together with
all statutory additions provided by Section 6321; and that the lien for such taxes and statutory additions
has thereby been released. The proper officer in the office where notice of internal revenue tax lien
was filed on 12-21-62 , 19___, is hereby authorized to make notation on his books to show
the release of saic! lien, insofar as the lien relates to the followinq taxes. .
NAME OF TAXPAYER
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. RESIDEtVCE OR PLACE OF BUS1NE55
P~r1t at. L~d~. F~! pt.~w. ~lo~ria~? -
~ AMOUNT OF
TYPE OF TAX AND PERIOD ; ASSESSMENT DATE ~ RfFERENCE NO. ~
~ ASSESSMENT
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PIACF OF FILING--- - ~ at.
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--<a Fo:'L Pia~+Ots !'lael~a
" Jack~onville~ Fla.
WiTNESS my hand at_ on this,
" 24 December 69 ,
the -----doy of---- - --<i ~ 9 .
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DISTRICI OIRECiOR OF iNIERNAI REVENUE ~ BY (Sig e) } TITLE
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_ A. J. 0'DONNELL JR. ! JACK DURANT ~ CHIEF-SPEC.PROC.S£C. t
(~vOTE: Certi6cote of officer author,ied by law ro take ocknpw(edgmer.ts fs n~t essentiai to the volldity of this document. G.C.M. 2A419, C.B. 1950-1, 125.)
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PART 3- To be used for recording purposes