HomeMy WebLinkAbout0422 ~ ~
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~ Fen~ 66~ U_ S. TREASURY dEPARTMENT - iNTERNA~ REVFNUE SERVKE Fa qp,ew~ Uu Br Reco.r.~y 01/a~ . ~
' fREV. 8-67) CERTIFICATE OF REtEASE Of FEDERAL TAX t1EN
~ DISTRICT SERIAI NO. !~OGER POITR~ (
~Mi~1L ~8~ 18074R B17~ ~10 ~QIFRK CIRQlNT~AWIT
~ 11ECOR0 MERlf
1 hereby c•.~~fr ~hor os ro ~h• followinq•oamtd toxpoy~r th~ reau'uen»nts af Stetioo
6325(a), I~t~~no) R~v~nu~ Cod~, Fwve be~n sotisfi~d wi~l~ respece to t}~e tox~s enu- ~ M~„~
m~ruNd ~Ir«, togethe~ w:tti oli stotuto~r ad~itions provid~d br Sectioo 6321; ond 71 ~
tlat the lien for such toxss ond statutwy odditians hos thereby been t~l~os~d. Yl~s
prop~r ofiic~r in the oific• wher~ ootice of internol revenw tax li.n wos iil~d on _ ~~~0
~1li1~R~ , 19 6q " is I~ereby outhor~:td to Inok~ nototion
on his books to show the rel~ose of soid lien, insofor as the lien rtktes to tM
iollowiny to:~s. ~
: NAME OF TAXPAYER
~cu o. ~ c.Lniu~s r. ~t
RESIDENCE
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CLASS OF TAX UNPAID BAIANCE
(Tox Rttutn Fwm No.) PERIQ~ ENDED ASSESSMENT DATE IDENTIFYING NUMBER • OF ASSESSMENT
(o ) (b 1 (c ) (d 1
~ LO~A~ 12-31~66 ~-~-iT ~.1~
~ 1+elro 3!•~z.6T S-zT-6~ s~-Slr-+l3~ - i1~•!!
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l
~ P~ACE ~F FILING a~~.
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' TOTAL i
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w~TNESS my hand or_ Jacksonville, F2orida on rh~s,
tt~e 1'~+h doy of June _~.19 71
S~GNATURE TITLE "
V M Lewis ~J _~Ac fin~ Chief, S~ecial z'rocedure sS~af;
(NOTE: Gr~ifiwt~ ol o;~ic~r o„rFAri~•d tr Iw. ?o to e oc4.~o..ledyTeets ~s not ~sseot~ol ~o !1vi +ol~o~ry of No~~ce o~ Fsd~ro~ To¦ (.i~~ G_CJYI.
1bs19. C.B. 195'JS1. 125.) 6~~~M ss
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PART 3-To be used for recorcling purposes
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