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Fom~ 6F8 oer~err~r oF n+e nEwSUn~+tEa+~t eEVa~,ue s~aMCe ror op~or~o1 us er R.oor~irg o1~c.
1~? t-'~) C~i/IUTE OF lBEAfE Of ifOBA! TAX t~fl
DISTRICT SERU1l NU.1~€R
Jacksonville, Florida ~ R ~
209927 R-192 P-2406 C1~
1 hereby cwtif~ ~hot os to the follow~og-nomsd roxpayer the requiremenh of Section ~ 01KI1t~1[~.¦r•¦•¦~"
• 6325~a), Internai Revenue Code, have been sotisfied with respect to the toxes a~u- ~
merated below, togeiher wifh oll stah?tory additions provided by Section 6321: a~d 4~~~~
thet the lien for such taxas and statulory addiiion: has M~erebp been releasad. The
Pr'oPK~a Z8ihthe of6ce where notios 4f inisrnd rave~ue tax lise wos filed on
y , 19 J 1, a heroby authorized to make norotion
on his books b show the release of said lien, insofar as the I~en relates ro the folbw-
ing taxes.
NAME OF TAXPAYER
A. W. Cooper and W. G. rooper
ttESfDENCE Keyway Products
i 4801 South Federal High~ray
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' UNPAID BALANCE
K1ND OF TAX TAX PERIOD ENDED ASSESSMENT DATE tDENTIFYING NUMBER OF ASSESSMENT
; !al t~1 kl Idl l~l
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! ' 941 6/30/70 12;11/70 59 1059473 341.Ob
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941 6/30/70 2 /26/71 " I50.80
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~ ~41 6/30/70 4/16/71 " 52.47
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~ PLACf OF FIUtJG
- rlerk~ Circuit Court
~ St. Lucie County TOTAL f 544.33
= Ft. Pierce, Fl~rida
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wITNESS my hand ot Jacksonville, Florida , on this,
,
- N,e 29 th doy of Oc tober 9 71
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SIGNA E T1TLE
- /l~ ~~~l~'1
- c urant
( E: Certif~cote of of6cer outhorized by tc,w ro td~e ackrwwled9m«,h is nor esseM~a! ro the val~day of Nw~u of f.d.rd to,c l~n G.C.M.
6t19, C.B. 1950-51. 125.) ~D~~~ ~ ~
PART 3-To b~ us~d ior neoedie~ p~repos~s
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