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p~ ~ U_ S. TREASURY DEPARTMENT - NITERNAL REVENUE ~RV{CE Fw OKwrl Nw By R~er1+, ONm
taev. e-6~t ~ tERT1FiCATE Of ~ELEASE Of FEpERAI TAX`!~N = p q~p RECO~QEO
DISTRICT SERUL NO. ~ :S'~', CIE COUNTY'F~.A.
- Jack~ionvilla, Florida 1 6453 166-1469~ ,.CORD VERIFIED
~ 1 Mr~by c~rtiiy tlwt os to tM foliowin~-qam~•~oxpA~rt~ th~ req~ir~n~sats of ~etiN1
'63Z5(o), jnt~rnol Rw~nw Code, hove b~fn so~i~~ied with nsp~et to tM taxis ~ni~- > ~
m~ro»d low, toy~~h~r with all stotutory ad~l~ions. provid~d by S~ction 6341; ~ q~ s~
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h~ l i~n tor svc b tox~s a n d stotutory_o d d i
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o ns l i os t h i~e by b ~en n l~os f d.~
= prooer olhc~r in tFN offic~ wh~ notice of ietN~no! ~w~nv~ rox li~n wos Fibd iw C
- : ~$v ~bth , ~9_,~LZ„
i~ I,er~by out6or;:~d to ~aok~ no~otioi~ $ ~
` wi: 6is beoks to lhow tM r~l~os• o( soid liiri, iesofor os ths li~n t~kt~i to ~t+i • Q~~~
: foi~~~~tox.:. - ''C RK ~I~G._IT . OURT
NAME pF TA~PAYER ' .
Ht1bi=t H11rst '
RESID NCE 'v
:205 North 39th Streat ~
°~t Pierce Florida 33450 ~ ' `
CLASS OF TAX UNPA10 BALANCE ~
(Tox ~t~twn Form No.) PERIOD ENDEO ' ASSESSMENT DATE 1DENTIFYING NUMBER ' OF ASSESSMENT
(o) ~b) (c) (d)
1040 12/31/65 5/20/66 265 OS 7688 404.64
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PLACE OF FILING
Clerk, Ctrcuit Court Tor~~ i yp4.64
St. Lucie CouaCy
Ft ierce Florida
WITNESS my hand ot Jacksonville~ Florid8 , on this,.
the 3~ doy of J~8 , yq 70
S NAT E ~ TITLE
Jack purant t~ief, Special Procedurea Staff
(NOTE: Cer~ilicot• d ofl~e•r o~rh«~:.d br lo~. ~o tok• ockoo..l.dqm~ms is not ~ss~nt~ol to t!u voliditp e( No~ie~ d F~d~ra) Ta: Li~n G.CJiA. •
26419, C.B. 195a51. 125.) e~~~
a PART 3--To b* used for ncordin~ purpos~s b
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