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Fomn 668 oE?NttMENr OF 7?IF nlEwSUer-MEa~UII REVEWUE SERVICE For Op?wwl (M M Recordng 016ce
(REV. t-70) • CQT~iCATE OF REIEASE Oi ~QA~ TAX L~N f~E 0 ANp RE~
D~STRICT SERIAL NUMBER iT.I~WE CO~TY~
~ 2-1311 8188 ?1332 ~°~Efl rom~ ~
CtE1t~ C~RCIIR
~~Itl..3~_i
1 hereby certif~? that os to the following-nort~ed taxpayer fhe requi~emenh of Section p 11EQIftEO
b325(c), Internol Revenue Code, hove beeo wtisfied wilh ~espett to the taxes anv-
merated below, togeM~er with oll statutory additions provided by Section 6321; ond
that the lien for such taxes and stot~tory additior?s hos thereby been releosed. 1he
p~oper officer in the of1'ice where notice of inlernol revenue tox lien was filed on
Nove~be r 20 ~ , 19~, is heroby avthorized to diake notation /~~.y
on his books to shaw the releose of soid lien, insofar as the lie~ rclotes ro the follow- ~v 1948
taXa.
NAME OF TAXPAYER ~ ! ~ ~
RESIDENCE ~ ~ ~
~t !l+~+~.~ ~s+ir-~31?~
UNPAID B~ALANCE
' KlND OF TAX TAX PERlOD ENDE~ ASSESSMEM DATE IDENTIFYING NUMBER OF ASSESSMENT
(al rol k) ldl kl
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Loio tat-~+o ~lr-~o-oi~~ ~t.s~
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4
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4
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5'
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3's
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" Pi.ACE OF FILING ~ Ci~~~ ~
z L~+~ GIf~ TOTAL S ~Z.J~
t1~~Ma ~~t
WITNESS my hond or Jacksanville . Florida , o~ rh~s,
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" !fie ~}h doy of APZ'11 , 19 T1
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~iGNATURE TITLE
e3
Jack Dursn+. Chief S c a ~r ed res St f
(NOTE Cert~6co~e of oRca out zed by i to toke ocknowled4yments n no1 r.senhol ro the .o6d~ty of Noncs of Federol Tax l~en G.C.M.
?6119, C 8. 1950-51, 1~5.) SS
~ PART 3-To b~ us~d for ncordin~ purpos~s
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