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Form 668 OEPARTMENT OF 7NE i1EASUlY-YiTERNAI lEVENUE SffY1CE Fo. Opranol ux 9r RecordMg OMc+
~~v i-~o~ CERTWUTE Of RELEASE Of F~DQAL TAX t~N f~lEO AND RECOtt~
DISTWCT SERiAI NUMBER S.lUC1E COUNTtt
IIOCEA POI~R~3
t~~ CtERK CIRCUIT COtM
1 hereby certify that as to the following-named toxparer the requiremenh of Section RECORO VE~~F~ED
6325(0}, internal Revenue Code, hove been sotisfied with respect to the toxes enu- !
merated below, together with all stotutory additior?s provided by Seclion 6321; and ~~S
tha! the lien for such taxes ond statutory additiau hos therebr been releaseci. Tha
proper ofE'icer in the office where notice of intarna) revenue tox lien was filed on
~?t~+1+.~. ? , 19.?1_, is fiercby authorized to Moke nototion
on his books to show the relcwse of said lien, insofor ~ the lien relates to the fol{ow- jI~013 .
i~g taxes. _
NAME OF TAXPAYER
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RESfDENCE ~
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UNPAID BALMICE
~ KIND OF TAX TAX PERlOD ENDE~ ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
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PLACE OF FILING
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=:A W{TNESS my hand af ~*_~L~~~•.1 Fln~id~ , on this,
aoox 1~o txcE vw
rhe_12t~dar ~f~ac~bar , 1911
;lGNATURE T1TLE
Jack Durant Ch e S
(NUTE: Cerhfiro~e o~ er vuthonzed by irnv toke ocknowiedgments ;s not rse~t~ol to the vohd~~y of Not~ce of Fede.ol Tox l~en GC.M_
= 26419, C.B. 19` - 1 ~ dd
N.:^ PART 3-To be used for recordiny purposes
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