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Form 66E , U 5 TREASURY OEPARTMENT • ~NTERNAt REvEHUE SE+tv~CE , Fr Opr ~ra! Use B~ Re~o.A.nq p~.ce A
REY_ 8-67: ' CERTIfICATE Oi REIEASE Of FEDER~I TAX UEM ~~E~
E COE r~.
DISTRICT SERIAI NO. ~~ER POi~t
Jacksonaille A able ~~lK CIRC~ ~OyA~~.
1 hereby ce?tify tho~ os •o the (otlow~ng-nom~d toxpoysr the rtquiremtnts o( S~ct~a? ~ YERIF~ ~
6325(al, int~rnal Revcn~e Code. hove be~~ sotislisd w~eF+ ~espect to the tox~s enu- ~~,~f
R+evated b~IcM, eoge~he. w~eh olf stotu~ay addit~a+s prov~ded by Section 6321; ond
tho~ the lie•~ ~w •_~ch foxes ond stotutay cddifians hos eh~reby be~n .~leas~d. Th~
prope. ofi~cer in the off~ce «1+e.~ no~ic• o~ internol ~evenue tox lien wos filsd on
.TunA 26~ , 19~_, ~s ~+sr~by autho?::ed to mok• norotion
oe? his books to show the release o~ soid lien, insoFor os ~he lien r~lotes to tM
Following ~e:~s.
NRME OF TAXPAYER
RESIDENCE ~ .
921 Nul 76 Terrace, Hollyirood, Fla. 3302l~: AM3
CLA55 OF TAX llNPAID BALANCE
' Tox Return Form No.1 PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) (b ) (c ) (d ) (e?
l~ho 12-31-68 05-30-69 055-18-3776 2,279.53
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~ ~~ACE OF F:UNG
~ CZ@2'k~ C~TCIl~t COt12't TOTAL S Z~Z'T9.53
~ St. Lucie Coun+.y
Fort Pierce, Florida
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~ +~''TNESS my ho~d ct Jacksonville, Florida on rh~:,
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~ ~e 7±h doy of _,_.19?1
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~ '~NATURE TITI.E
~ Jack Dur~nt, Chief, Special Procedures Staff
:'NOTE: C~,r~i:co~~ o~ otf:ce o~h i~d r Ie. +o ro s oc nowl~dqT.~n~s ~s no~ ess~n~~ol •o iM ~ol~d~rr o~ ?~o~~c• o~ ~ed~.ot To, L~en G.CJA.
~ 24419, C.B. 195451, IIS.1
39
~ PART 3--To b• us~d for recordinq pu?pos~s .
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