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! Form 668 DEPI1tT1NEliT Of TfE TeEASIl~r-N?E~il?t RFVENUE SERV~CE Fe~r Opwwl U~e ~ Recadng e
~.~o~ cernu~ oF a~eu~ tuc ua~ o ~Mo
DlSTRlCT SERIAI NUMBER ~T (
,y,~, ~ ~EO vEluflE~~
I he.eby cerriy Nw~ cs ro ~he follow~ng-nomed ro er the r uirements of Section ItEC01~
6325(a~, Intemol Reve~ue Code, hove been ~otisfied with respect to the taxes ertu- ! f `
merated below, together with oll stotutory odditions provided by Seciion 6321; aod f~ Ms
that ihe lien for such toxes and statutory addfions has thereby been reteased. The
proper ofi'icer in the office where notice of internol revenue tox lien was fikd on A~~
NevemhwT ?(1.~ , 19~.Q_, is hereby authorized to ~oke notation Z
on his books ro show the releose of wid lien, insofar os the lie~ rclata to the follaw-
ing ~axes.
NAME OF TAXPAYER ~ ~
, RESIDENCE R
~~r~ ~ ~
UNPAIO BAUNCE
KIND OF TAX TAX PERlOD ENDED ASSESSMENT DATE IDENTIFYiNG NUMBER OF ASSESSMENT
la1 ro1 k) Idl k1
' fil 3-~-TO i•~6•7~ ~-3L6~Y ~41~.~0~
` li~l 6-30-10 l~5-70 ~l~~k17 ~.TS
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" PI.ACE OF FIUNG Q,i~~,
_ ~ ~ TOUL S
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~ `NITNESS my hand ot .lacksenvi lle ~ Fl eri da , on th~s,
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rhe fit.h day of~nri ] , 19 7] -
S~GNATURE TITLE .
~
ry Jack D ranf i~l Procedures Sfaff
~ (NOTf: Cerhficote of cer thoraed by ~ow ?o Ioke ccknowledgmenfs ~s not essent~ol to the vaLd~ty of Nohce of Fedcrol Tox t~en G.C M
i.~ 26I19, C.B. 1950-S1,
~ PART 3-To b~ usad for r~cor~~inp purpos~s ~U~X~ i~~
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