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Form 668 U. S TREASURY OEPARTMENT -~NTea~:a, vEv~NUt SE3Y':E F~. C~pr.~.,o: Uu er Reco~d~~y 0~( c~
,hEV 8-5~'~__ ~ERTi~lCATE OF REIEASE Of FEDERAI TAX UEN _ ~ ,i~~EO Eo •
DISTRICT ~ SERIAL NO.
~cw~~iLl~~ r1a~i~ ~ iq,3~ e~~t,~~?.~_____ ciE K c
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1 hereb, c~r~ify tAot os to the (otlowing-nam~d faxpoyei the reQu+rements o f Soce~on ~ ~ R ~ F .
6325(0), Internol Reve~ue Cod~, hove be~n satisfi~d w:tF respec+ to the tases cnu-
merated b~IcN, togethe~ with oll sta!utwr odditions prov~ded by Section E321; ond
thot the li~~ ~or such toxes end statutwy odditians hos the.eby been relecsed. The
proper oflicer in the of(ice where notice of interno) revenue tox lien wos f:led on
N~ 7/+ , 19_,~a, is 6ereby ou~hor~zed ta moke notot~o~
on his books to show the ~tleose o( said (ien, insofor os the lien rtlates to the
Iollowiny toxes.
NAME OF TAXPAYER
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RESIDENCE •
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CLASS OF TAX UNPAI~ SALANCE
tTox Return Form No.) PERIOD ENDED ASSESSMENT ~ATE ID~ TIFYING NUMBER OF ASS :SSMENT
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~LACE OF FILING C~~~ CZ~~i*i C~ti
st• j~Mi~ C~~ rh TOTAL S
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'~ITNESS my han~ at Jackeonv~, Flnrida on this,
' tne~~h _ dcy of __~S~L ,19 71 - - - - -
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SIGNA7URE TITLE
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Jac D~~t _ ' ~B~.~
~ 'NQTE Ce,.,i~core o{ oii~c r eher,a~d b~ lo++ ro ~oks ackno»I~dq~++sney .s ~,o~ esa~~~ ol to ~h~ .al~d~ty o( Not~e• o~ Fsd~rof o. 1~+• G.C.M.
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I6~ 19. ~ B 195~151. 125.1
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~ P ART 3--To be used fo~ n g pur pos~s
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