HomeMy WebLinkAbout2133 . . _ _ . _ . . . . . . _ ~:i~i.r:.7~'C~~~ . ~ i~= .
_ ~ G ~~r; ~ ~-,~*Ra5 G
Form 668 DEPARtt~Er:i OF iHE iRE/~SURr-WTERHA! REvENUE SE!'PICE For Optonol Usr Ey Rern~ng
(REV. 1-70~ C~~u~ ~ ~ ~~l Y~ ~
p~$T(tICT ~ SERIAI NUMBER ' 1.E0 ~MD RECoR
6Eit Pp!lR~t ~
.ii+C4~=i~ia l1~1Y 210620 Bl P ~~.~~tE GOUMTr ~
QLERK C:~GNit QppRT
f hereby certify that as to the follow~ng-n~med taxpoyer the requirements of Section RfCORC 11[R'f1ED
6325(0~, irnernal Revenve Code, have 5een satisfied with respect to the lazes enu-
merated below, together with all statutory odditions provided by Sechon b321; and j~ ~3
that the lien for such toxes and statutory additions has thereby been releosed. The w
p~opet officer in the of~'ice where notice of interna) revenue tax lien was filed on
.1une lly , 19_~, is ??ereby authorized to rt~ake nototion
on his books to show the releose of said lien, insofar as the lien relates to the foUow- `~~ls~
ing taxes.
NMAE OF TAXPAYER
~
RESIDENCE
~ ~ ~
t ~O~~+t t~~ ~K~
UNPAID BALANCE
' KlND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDEMIFYING NUMBER OF ASSESSMENT
4 lal fbl k~ Idl l~1
;
- i~ Oq l~-~l-i~ ~~7r 37 bitl+iS i 3s~S7.2i
~
;
;
~ !~s dr iiw is~o~ ~s 1~71 is
s!1 ~s iy ~s dr ~r~r~rc aer ~
- ? ~eL M f• 1r~~ri ~t
~
~
~ ,
~
~
"3
~
PLACE OF FILING
CL~~ C~ O~lt TOTAL S s~~ST~
- tt,. L~si~ t~t~
~ r.e: s~a+os, r~.rs~.
WITNESS my hond at J~C S oII1I~1.18 Fldri da on th~s,
1Qth Janu 72 E~( PACE ~3JV
= the doy of ~y , ? 9 -
SIGNATUKE -T-~1TLE
Jack an Qtief, Special Prooedures Staff
(NOTE- Ce~hf te of o er outho~~~ed o f~w t: t~ke ockf,c~wlev+~me^ts ~s not essenha~ to the vo~~d:•y of Nohce of Fe~ra~ Tox L.en G.~.ht
~ca!v, c.B. , i~s ~ • aa
- PART 3-To be used for recording purposes
;
-