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Forw ~a U. S. TREASURY DEPARTMENT - INTERNA~ REVENUE SERViCE Fo+ pp~onel Use 8~ Recad.ng OI(~c~
(REV. 8-67? CERTIFICATE Of RELEASE Of fEDERAI TAX ~IEN
DISTRICT SERIAL N0. ,
~~p~,,~ 178956 O.R.Dk.177 p.2819 FILEO AND RECORD
I herebr ctrtify thot os to the following-namad foxpoyer ths reQuirsm~nts of Sectioa $T. LUCIE COUiVTY. EO.
6325(0), (nt~rnal Rsvenue Code, hove been satilFied with respect to the tox~s env- f,~CC~~ FLA.
' m~rated b~lew, together with oll stotutory additio~s provided by S~ction 6321; und Q~~ n~~EO
~ that the lien fo~ such to:es ond statutwy additions hos thereby been rsleos~d. The ~~7C7~~
proper Joffu~~ ~n the office where notice of internol revanw tox lisn was filed o~ f7o PM
, 1q 69 ;s hersby~outho~i:ed to moke nototion ' J~N 27 2• Sc
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on his books to show the releose of soid lien, insofor os the li~n ~~lotes to the -
followin9 toxes. '
NAME OF TAXPAYE ~v-l~?; = v~; R~~S
CLERK CIRCUIT COURT~
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RESIDENCE .
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C1A55 OF TAX UNPAID BALANCE
(Toz Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(01 ~b ) (c ) ~d ) (e) .
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~ PLACE QF FILIN(# ~,,3~t+ a~
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~ WITNESS my hand ot Jackaomrill~~ llorida - , on this,
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~ the~_doy of Janwrg ,19 70_
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(NOTEc Grtificote' oF officer avthwi:e Ey Im+ to toke ocknowl~dpments is not essentiol to tFN raliditr of Notice o( Fed~rol Tox Li~n G.CJiA.
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PART 3-To b~ used for recording purposes
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