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Fonh 668 DEPARTMENT OF TNE rikASURY=NTElNAt ~EVENUE SERYKE fvr Opionol (h~ M Reoor OA9ct
! ~~v ~.~o~ tHT~1CATE OF REIEASE Of ~O~At TAX UEN s.~uc~e o
~ DISTRICT ' SERtAI NUMBER IIOCEa POITRA=
~IERK CIRCWT ~OtM
' 1 hereby certify tlwt as Io the following-named taxpayer the req~irements of Section RECORD vERiiIED
! 6325(0), Internal Rev~enue Code. hove been satisfied with respect to the taxes enu- ,f~ ~ t
~ n~rated below, togetl~ with all statutory odditions provided by Section 6321; ond w~ ~ 1
i thot ths (ien for such taxes and statutory additions has thereby been rdeosed. The
proper o1F'icer in the office wherc notic~ of internol revenus tax lien was filed on
Fe~-'~uaY'~ 2~ . 19~~, is hereby authorized to Miake notation 21.4938
on his books ro show fhe raleose of said lieo, iraofar as the lien relates to the follow-
ing toxes. -
NMAE ~ ?AXWIYER
1
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UNPAID BALANCE
i qND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYtNG NWNBER OF ASSESSMENT
la? rol kT fd) le)
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' ~1 ~Itl1r~1~~ M•~~ 1i•~•~ l~•M~M ~ l,~'l.~i
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~ PIACE OF HIING _
Q~ TOTAL S i~+~
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WITNESS my hond ot ~T~CY~022V~1~8~ Florida , on M~is,
~ .
~ ~ 2c+.t? ~y of rugast 1971 0 R
~ , _ '
~ SIGNATUR 71TLE ~
i~'d~%w
Ja an ~h ef ~ t
~ T Ce.tdicnte ol oR'icer ov~horu~d by Ivw to tnke acknowiedgm~~tt is not essenhol to the vol~dey of Nonc~ of Fedaol Tax t en G C.M.
, C.B. 1950-51, 125 ~
PART 3-To b~ ut~d fw r~to?dinq purpo~~s ~
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