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fonh 668 DEM[rMEt~R OF nE nE~W~e+r-.aiiHPlAI ~EVFNtJE SE~1CE For Opionol th~ sy R~co~dnp 016c~e
(REV. t-70~ ~QTi1(wR ~ R~EASE 0~ ~Al TAX l~! ~ l~~ i ab. ' ed
DISTRICT SERIAL NUMBER r rt ~
~ 1Q9544 B•187 P-1781 ~
I hereby certify thot os to the followi~numed toxpayer the requiremenh of Secfion ~
6325(a), Inte~r~l Revenus Code. havs bee~ wtisfied with retpett ro the toxes eiw- ~ -
mefated below, together with all stotutory oddifions provided by Secfion 6321; ond
Mat tM lieo for such taxes ond statutory additions hos ttKreby been releosed. The
proper officer in the office where notio~ of in4ernol revenue rox lien was fikd oa
[)c t ob e r~~ h , 19_IQ, is hsreby autfiorized to rriuke notation
on his books to show the ~elea~e of said lien, insofor as rhs Gen retates ro M~e follaw-
ing taxes.
NMAE OF TAXPAYEit CjiAf~s Y• ~~W ~J~~
RESIOENCE ~ ~ ~ ~
~ ~a'~ lLs+M~ h!l~i~~~
uNPNO s~?uwcE
; KIND Of T/~X Tit?X PERIOD ENDED ASSESSAAENT OATE IOENTIFlfING NUMBER OF ASSESSMENT
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' PLI?CE OF FtUNG Q~~i/
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si. L~~s ~ TOT~u j ~iid~~~
M. nrw~ tL.
Jackson~~ille, Florida
WiTNESS mr hond at , on this,
-
- ?he ?`'th doy of Octoher , ly_ 71
- S~GNATURE 71TLE
= Jacl~. D -~A Chief, Special Procedures Staff
( , CM o'i~ce. o~rhonzed by low to take «krrowledgmenK ~s not essenho! fo ?i~e vo6d~ty of Nonce of fed~d 1ox l~en G_C.M.
= 2 , . t950-s1, 125.) ~
_ PART 3-To b~ vssd for ~eco?din~ pu~pos~s
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