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• Fona 668 U_ 5. TREASURY DEPARTMIENT - ~NTERN~~ REvEt~uE SERVKE ~ Fv Op,o.d Use 8~ Rcc .q ON~c•
~ (REV. &67) CERTtiiCATE OF RELEASE OF iEDERAI TAX tIEN
i DISTRICT SERIAL NO. i81(~OZ FiLED aND RECOROED
T. LUCtE ~OUNTY. FLh.
OR 178 Pa e 2851 ,~^r. t,~~r~r~r~f
i I hereby c~rtify thot as to the (ollowing-nom~d toxpoyer t~+s~r~quirem~nts of S~ction 19~19
I 6325(0), Int~rnal Revenue Code, h~ve been sotisfied with respeel to the tarss env-
~ meroted b~lew, together with oll stotutar edditions provided by Sectio~ 6321; and ! h PM 1~( 9
~ thet the lien for sueh taxes ond statutory additions Iws thereby been releos~d. TM ~ 1`~,
~ proper officer in the o(fic~ whers no~ice of intsrnal revenue toz (ien wos filed on ~
; July 24 , ~q~~s hereby outhorized to moke nowtio~
on his books to show the releose of soid lien, insofar os the litn relates to tl~e =r-~t ~ n~TqQ
Followin~ tox~s. : CL~RK CIRCUIT COURT
NAME OFTAXPAYER
R~O~R! B. lBZiD~P, !'M~ Di ~ppl~~f~o~ 1Npai! -
RESIDENCE
; ~lb O~n~ Lq~, Pi~rc~~ ~l~arsd~-33b5t~
CLASS OF TAX . UNPAID BALANCE
(Tax Return Form No.) PERIOD ENOED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~o ) ~b ) (c ) ~d ) (e )
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~ 9h1 12-33tb8 T-4-69 59-111~T3h 53t•7k
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' PLACE OF FIUNG ~
~ $t. IinCL~ t3ovntf
~ ~r~ ~~l~i> TOTAL S rj~~~
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~ WITNESS my hand at Jacksonvills, Florlda , on this,
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~ rhe 13th doy of April ~ ~q 70. ~
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~ SIGNATURE TITLE
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Jack Durant Chief S ecial Procedures Staff
".,Y'~'sE, (NOTE: CertiFicote of officar outFwri:ed by low to toke acknowl~d9mems is not ~ssent~ol to the volidity of Notiu of Federol To: Lisn G.C.lN.
~,z 26119. C.B. 195P51. 125.) e~~~~ ~ tPP
~~i 490 ,
- PART 3-To be used for recording purposes ;
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