HomeMy WebLinkAbout2130 . . . . . _ _ . , . _ , _ ~ y~^j _ _ _ . r
rotm 668 DEMRTMENT JF Tt1E TIEASURY-MElNAI lEVfNl1E SERVKE For OP?~onof U~e By Rtcwdng
(REV. t-70) CQT~iCATE OF RELEASf Of FED~1?l TAX UEN f lE0 AN~ RECp~p~,
~~crwrT cFQi.~ N~ wutFO 3~. 4YCIE_COIIMTr ?~A. ~
,1
~j~ •---2Q2258 H188 P2886 CLE K CtIICWT COrAt.~l~ -
I he~eb y terti f y thot os to the folbwi n g-named taxpayer the ~equiremer?h of Section RECOAO YERIf1E0.~...i.
6325(a). Internal Revenue Code, hove been satisfied with respect to the taxes enu-
merated below, rogether with oll ~atutory odditions provided by Sectio~ 6321; ond "~~~T t
tFwt the lien for such taxes ond statutory odditions hos Mnreby bee+~ released. The
; pro~er of~'icer in the oli'ice where notiae of interncl reve~ue tax lien wos fikd on
~ I)BCAbbe2` 1,~.~ , 19~(), is hereby authorized to diotce notation
~ on his books to show the releose of said lien, i~ofot os the lien relates to the follow- ~~~~+7,7 ~ 3
~ng taxes.
F NAME OF TAXPAYER ~
r
~ RESIDENCf
r
~~Ma~~
3
f UNPAID BALANCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMEM DATE IDENTIFYING NUMBER OF ASSES~ENT
~ lat (b) kl ld1 ~~l
~
~ y1t3 6i•~l2 5-l~-7~0 ~ ~•5~
~ ~ 6~-~t S-~d~~ o1t 6Sl.f~t
~
~
~
~
~
~
~
~
ti~
~
PLACE OF FtLING
~ TOTAL
s~. ~,~.s. o«~ ~,.~?,s~
_::s Et. rs.~., l~.rs+i.
WITNESS my hand ot JaCk80TN~118. Florids , on this,
r7e 3rd ~y of December , t 9
` COK PACE
.-J
~ ~ S!GNATURE TITLE
a
Jack
- (NO ~ Cert~f e of off'iccY autfiar,zed by !ow to toke ocknc+~ledgments n not essenhal to rhe vaGd~y of Nohce o ol To: l~en G.C.M.
264 . . 1950-51, 125.)
- aa
PART 3-To be used for recordiny purposes