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- Fo..r bbs U S. TREASURY ~EPARTUENT - INTERNAI REVENUE SERVICF Fw p~r.o„o; us ~er Reco.e..p d(~c•
~REV. &57.: . CERTItiCATE OF RELEASE OF fEDERA! TAX LIEN f o~o rtECO+~E
DiSTRICT SERIAI N0. ~jKlQ C01~MTT
~ 116C£R P01?ItA:
a CLERK CIiCUI? C
1 I,e~eby c~rtify thot os to the following-nom~d toxpoyer the r~qu?rements of S~c~ion RE~O VfRIF1E0
6325(01, Internal Revsnu~ Code, hove be~n sotisfied w~th respect to the to:es enu-
me~ot~d b~lc«, toge~her w~th all stotutorr additions provid~d by Section 6321; end ~ 13 3~i~~~
thot the lie~. ~or such to:es ond stotutory odditians I+os rhereby been rtleas~d. TF~e
pro{»r officer ~n the office wher~ notice of int~rnol revenue tox lien was f~lad on
~Tan ~~r~r~a„~ , 19
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- is her~by outhorized to moke notatioe
on his books ~o show the releose oI said lien, i~sofor os the lien ~elotes to th~ ~~Z
followinp tor~s.
NAME OF TAXPAYER
RESIOENCE
Aoute 2 Box 881
CLASS OF TAX UNPA10 BALANCE
;To: R~turn Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
; (a 1 ~b ) (c ) (d 1 (e 1
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' l01~0 12-31-63 07-1l?-67 2bb-52-9714 526.16
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~ lolt0 12-31-bb 0?-1l?-67 266-52-9711~ 511.16
~ lOtiO 12-31-bs 07-1t~-67 266-52-9??L 1~62. ~5
~ iatjo 12-3i-66 09-15-67 266-52-~7i4 2~.t~1
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F~ACE OF FILtNG I
~ Clerk of the Circui± Cour± rc~c~r~c~t~ in O.~?. t~ok TOTAL s 1~?gl?.5g
St. Lucie County 1~0, ~,ge 63-~
~ _ Ft ~'ierc@., Flerida
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~;TNESS my har,d ot Jacksonvi~ ~ e, F~ or{da , o~ ih~ s,
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~}1e 6Lh dQy of AU2i1 __,19TI -
SIGNAT E TITLE
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Jac ra t _ p...Y.A~~~~ a S,#~rp
iN E= Grtificort d office. Ou~~'p~ie~ br IOw ro toke ockno»ledq~nsn~s ~s not ess~ntrol to th~ ~ol~d~~~ of Na~c. o~ Federol To: L~en G.C.AI.
~ari9, c.s. ~9so-s~. ~~s.~ 0 R
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~ PART ~To be ussd for recordiny purposes
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