HomeMy WebLinkAbout2954 , ~ • ' , ~ -
Form 668 oEr~ur,~NT oF n~ reEwwrr-aarfs~ ~ver,uE s~wcF Fo. op~ood u,. e a d~ or&e
(REV. 1-70) ~QT~CA~E ~ R~EASE ~ ~ED~A~ TAX ~I ~
DISTRICT SERIAL NUMBER ~
t~~ ~4~
1 herebr certifY that os to the folbwing-nomed toxpayer the roquirements of Section ,
6325(e), Internol Reve~ue Code, have been soiisfisd with ~espect to the taxes erw-
m~ated below, bgether with all statutory odditions provided by Sectio~ 6321; ond ~
that the lien for such toxes and statutory odditia~s has tF~ereby been releosed. The ~AR 9.q.~ A•~
proper o1F'icer in ths oRce whera notice of iniernol rewoue tox tien wos flled on
~tpbgr 9- . 19~~, is herebp avthorized to n'lake nototion
ore his books to show the release of said lian, insofor us the lien relates ro the folbw- ~~i 7
ing taxes.
NMAE OF TAXPAYElt ~•s
t
RESlDENCE
7;'~V~ ~=a~~ tw•~
l~rt rl+~ert~ lj~eL~-~~
UNPAID BALANCE
KINO OF UX TAX PERlOD ENDED IISSESSMENT ~ATE . f~ENTIFYING NUMBER OF ASSESSAAEIYT
k tol roi kl ldl lel
~
k
: ~ ~..jo.~ l-11•T0 9A-slti6iltT ~1.LL
e
;
i
~
;
~
~
~
,
~
~
s
~
~
~
~
~
~
~
v
~ PI.ACE OF FfLtNG ~s~~
~T
SI'. a~~ TOTl1l s ~u
~ l'f~. !!~!'Ma !~M'lr
~
m=
~
~ WITNESS mr hand at Jacksom?ille, Florida , on ~his,
~
~
rhe doy of Mst'Ch , i 9 71
~ -
SIGNATURE TITlE
~ (NOTE: Cert~ficote of ofFic o tha~ze by Iaw to toke ocknowledgmefh ~s not essenhul to the valid~ry of Nohce of Faderol Tox l~en G.C.M.
26t19, C.B. i950-51, 1 0 Q ~.'vW 8a
4~
~ PART 3-To b~ us~d for rQCOrdi~
-
~ - . -
, ~ ~
_
_ ~