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Focr~ 663 - U. S. TREASURY DEPARTMENT - iHTeaN~~ aEVENUE SEttv~tE Fo. oo•,a.et Use Br R«ad~.y Oll~c•
(REV. &67) CERTIFICATE Of RELEASE OF fEDERA! T~X LIEN F~~O AND RECQR~D~D~1
DISTRlCT ' SERIAL NO. igS7(~+ ST. I..UC1E COUN 1 j. ~LA.~
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- oR s p8 a 2s C1Ri: VFRIFI o
ere y certi y t ot os to the followiny-nom~d toxpoyer the requirements of Ssction ~9~`?'10
6325(a), internol Reve~~e Coda, Mve been satisfied with respect to the toxes enu-
meroted belew, together with oll statuto~y odditions provided by Section 6321; ond ~TO APR 28 ~ i~•~"
thot the lion for such taxes and stotutwy additians hos thereby been released. The
' aoper officer in the office where notice of intemal re.enue tax lien was filed on ~
November i$ , 19 69 ;s hereby author~sed to make nototion .
~ on his books to show the releose of soid lien, insofar os the lien r~lotes to the t~U~` ~'~~TR~S j
CLERK CI CUIT COURT~
Followiny toxes.
NAME OF TAXPAYER
~o~ x ~ a~s~ s~uaNt
RESI~ENCE
49~ 9~ PRIIU YI9TA
CLASS OF TAX UNPAiD BALANCE
(Tox Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(a) ~b) ~ (c) (d) (e)
l.a-31-~ ~+Z3-~9 ~-1.~-'31a0 S, 652.?.Z
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~ PLACE OF FIUNG
; Gl.~t~(, CIBG'~tIT G(XB? TOTAL S s,(~~~
~ L~i~Ib COtAi17j t? PI~RCa, ~LOB1vA
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~ WITNESS my hond at Jackeonville, Florida on this,.
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~ rhe 22°d d of April 19 70.
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~ J Durant Chief, Special Procedures Staff
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r~ (NOTE: C ~licott of olFiur avthori:ed br low to toke acknowledymen?s is not essenfial to ~he val~ditr of Notic~ of Fed~rol Toi L~~n G.CJiA.
26119, C.B. 195d51, 125.)
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PART ~To be used for recording purposes
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