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"S U. S. TREASURY DEPARTMENT - tNTEeN~~ rtEvEr+uE SEttv~[E c„ Fd OM~a~.~ Us~ By R«xd~ey Orf.c~
' ~k~ CERTIfICATE Of RELEASE 0~ iEDERAI TAX LIEN ~
' DIS: R~ sEaia~ No. - _ 'F{LEO AND REC01t0E~~
~ti~~~~~ ~L~~ 181000 OR k 78 P 2 9 T. IUCiE COUNTY. RLA:
1 F+ereby c~~tify that as to the following-nam~d toxpayer th~ rta~ireen~nts of Sectio~ R~COR~ VERIFIED
6325(0), intsrnol Revenue Code, hove been sotisfied with respect to the tax~s enu- ~~`~Q
msroted b~lew, togNher witl~ oll stotutwy odditions providsd by Section 6321; und 0
~ thot the lien for such sozes end stotutwr odditions hos thereby been rtleased. The ~1,~ 1_~ aj 3~ O
~ proper officer in the office whers notica of internol revenue tox lien wos filed on ~W ~ ~
July 24 , 19 69 is hereby outhorized to make nototion ~
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on his books to show the release of soid lien, inso(or os the lien rtlotes to the ~OveR ' O~ AS
followinq taxes.
: NAME OF TAXPAYER CLERK CIRCUIT COUR7~
?~lAS 1~? ~ io~t T~~ta~ ~ ~fS+O la~ic ~
' RESIDENCE
; j~ OlN~~ HZi~d.~ Ft. !l+~+o~~. l~L~e~+iMj~4'~
' CLASS OF TAX UNPAID.@_ALANCE
! (Tax Return Form No.) PERIOD ENOED ASSESSMENT ~ATE I~ENTIFYING NUMBER OF ASSESSMEI~4I
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; WITNESS my hand at Jacksonvil Flnrida , on this,
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rhe~? doy of Hay ,19 70
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SIGNA7URE E
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(NOTE: rtificat~ of oflicer authoriied br law to take ockno..ledymeMS is not ~ss~ntial to tF+e rolidity of NNice • eral To¦ Lien G.C.M.
26119. C.B. 195P51. 125.y Q
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¢ PART 3-To be used for recording purposes
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