HomeMy WebLinkAbout0249 Form 669 DEMR~MENT Of iHE TRLASU[1/-NTERNAL REVEt`UF SERVICE rv. O~o~w~ Us. Ar R«ord~ 016c.
~~v. i. ~a~ CERT~ICATE OF RMEA3E Of fE08tAi TAX i1EM ~jL ~E OE~ I
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DISTRlCT SERiAL NUMBER ' `
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i herebr cerr?fy ~,at os ro the foltow~r,~-~c,med toxporer rhe rcqui:sst,~ss ~f Saciioa RECORO
6325(a), Inte~nol Revenue Code, have lieen sotisfied with ~espcct to the toxes enu- ~
merored beiovr; together evith ali stututory additio~s provided by Section 6321; ond ~'r 3'~
t h o t t he lien fer s u c
h roxes a n d s
ta t u tory a d d i fi o n s h a s t h er e by b e
e n r e
l e a s e
d. Th e
; proper ofFicer in the office where notic~Qf inlernd revenue:tax lien wos fited on .
June 14 , 19 1, it hereby authorized to ~ake notation
on his books to show the ~elease of said {ien, insofar os the lien relates to the folbw• •
ing taxes.
~ yt1ME OF T/1XPAYER • ~
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' RESIDENCE '
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; UNPAID BALAI~KE '
~ KINO OF U1X UX PEi~OD ENOEO ASSESSMENT DATE IDENTIFYING NUMBER OF ~MEM
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PUCE OF FlUNG Q,,ts~*,
z: ~ ~ TOTAI = ~~3T
yy~jNE55 my hond a~Jacksonville. E'la. , a, ~,a,
, 4th ~y of Novemher~9 71
SIGNATURE TITI F
- Jack~L Chiaf, Spe~ial Procedures Staff
~ TE: cwe o officer w:tfion:ed by law to take aknowledgmsnK b not essent~d b fht vdidty of Tai l~w G. JYl
° . C.B. 1950-51, i25_~
PART 3-To b~ vs~d fo? nco~ pwpos~s -
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