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~ F«~n 668 oenutt,~rrt oF n~ n~wsue+r~n[~wu ~v~ s~ncE w. qpr~wal u,. er Rec«d~.~g olFc.
(REV 1-70) CHtTHCATE Of RELEASE OF FfDQAI TAX l1EN F LEO ANQ aE
~ DISTRICT SERIAL NUMBER i~. l`10CER T
199763 B-187 P-2053 ~~ERK CiRCt11T ~ ~
1 hereby certify thal as to the folbwing-named taxpayer the requirements of Section IIECOItO YER~f1E0
6325~a). Internal Revenue Coda, hove bsen sotisfied w~th respect to the taxes enw
meroted below, together with all srotutory-cdditions provided by Section 6321; and
thot the lien for such taxes and statutory additioris has N~ereby been released. The
proper ofF'icer '-the oli'ice where notice mferna) revenue tax lien was filed on ~~5
~ Octobir l~th , 19 , a hercby auMwrized to niolce notation
on his books to show the relcose of soid lien, insofar os the lien relata ro the follow-
ing taxes.
NAME OF TAXPAYER
~A~ .
kESIDENCE
T~ 0. ~s 3,~i
t!~ !~Sl~is
' UNPAID BALANCE
KIND bF TAX TAX PERIO~ ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSMENT
I (al tbl kl Idl fel
E ~oi~ 1l~.~L.6~ 6~6~6~ ~3~t~-71~~ ~l~•7~
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~ LOirD 1t•31.b~ 5-~-70
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~ PLACE OF FIUNG
~ ~ j~L Q~ TOTAL s ~T~.~
~ , ~ Tiet ~irrN~ TLwel~
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~ ~ Jacksonvillt, Florida
~ WITNESS my hond at , on this,
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,`,e 17th ~Y of M+.y , 19
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~ ~~GNATURE ~ T1TLE
~ V~riwa Lel?i A~cting Chief, Sp~cial Proc~dura• staff
~ (NOTE: Cert~ficote of ofFicer outhorue by law to take ocknowledgments n not r.senhal to ?he val/~~fY of N ce of Federol Tax lien G.C.M.
~ 26419, CB. 1950-51, 125.) ~
~ PART 3-To b~ usad for r~cordin~ purpos~s
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