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Fonn 668 .
(REV. 1-70) ~~T~A~ ~ ~ T~ ~
DISTRICT SERU1l NIJMBER ~
~r t
~ ~E~OR! 11ER~~
I hKeby certifir thot as 1o ti~e following-nomsd 1~axpayer ihe roquir~ts of Section
6325(a~. Internol Rev~enus Code. hove besn salisfied vmth respsct ro the toxes enw
mKOted balow, togelhe~ with all statutory additioas~rovided bY Sxtion 6321; and 1
thot the lien for suth taxes and statutory adcliiions has N~ereby been releosed. 1he
proper of~'icer in the office where notiu of iMernol rev~e?ue rox lien was filed o+~
(~c~+eber 9= , 19~~, is Fwnbr awhorizea ro rtioke ~ototion
on his books ro show the releose of said lien, iroofar as the lien relates to the folbw- ~7~~
ing toxus.
NAME OF TAXPAYER
~as s a,~s ~s
RESIDENCE ~ ~y
~ ~~N~
UNPAID BALANCE
~ KIND OF TAX TAX PERIO~ EN~ED ASSESSNIENT DATE IDENTIfYtNG NUMBBt OF ASSESSMENT
f !al ro1 i~1 ldl lel
~
~
~
s
~
~ j~p j~.,~,"y S"~•~ o ~J+7!
~
~
~
~ -
~
~
~
~
~
~
~
~
~;r
~ PU1tE OF FIUNG C1,~~ ~s~t ~t
s_y ~ ~ TOTAL S ~j~'A
~j ~f. niq~N~ t~•
~
WITNESS my hond at Jacksonville~Florida , o~ th~s,
g~.~
~t
i±~
~ r?,~ 1 th dcr of Ap.~`~_, 19T1
s=
N:fi
~
~y>
~x SIGNATURE T1TLE
~=4
6c~ l
~ T
~ ~
_ (NOTE: Catificate of vt iie~ by law to toke ocknovrledgmenh is not essentiol to the vofidity of Notice of Federd Taz lien G.C.M.
26419. C.B. 1950-51 125.
`h~" PART 3-To b~ u:~d fw ncordin~ purpos~s ~
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