HomeMy WebLinkAbout2939 form 668 DE?IIRTMENi OF iHE TRfAA/d -NIEWAI lEVEr+IlE SEMCE Fo~ Op?ww~ Use 8y Recwdng OFFce
;r~v. t-70y CERTi1CATE OF REtEASE OF FED~AL TAX L~N
D~STRICT SERUL NUMBER
Ji~Icr+MrilL ti~slr 215233 ffi
i hereby certify tiiot as to the following-named toxpayer the requiremenh of Section
6325(a), Internal Revenue Code, hove been wtisfied with cespect to the taxes enu-
merated below, together w~th all stotutory odditions pfovided by Section 6321; and ~j~s~
thot the lien for such toxes and statutory additions has thereby been released. The 1f+1~+1Gr`.~
prope~ officer in the of~'ice where notice of internal reve~ue tax lien wos filed on
SB,~tesber ~ , 19~1, is hereby authorized to rtiake notation
; on his books to show the release of sc~id lien, insofar as the lien relates to the foltow- f) LEG ~y; Rf COROEQ
s iT.IUCIE COUMTY FIA.
' "'9 tO7~' ROCE~ rO~TR~S
~ NAME OF TAXPAYER RfCORD vEft jc~ COU11T
€ ~L i~.
~'~~1 ~rla ~ - Z ~ /1 • ~ • ~w w
; RESIDENCE ~ ~ Z~ ~ IC
~ +~t~l S. Tad~e~1 1~4•s
` ~st ri~e~ !le~eli~.,31~
x
~ UNPAID BAIANCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMENT OATE IDENTIFYING NUMBER OF ASSESSMENT
~ (al (b1 kl (dl ` (el
~
~
h
~1 3Z-~70 6-~-Z1 59-si~6~1~,~ ~k~TT
z
~
-
~y
y_:
~i
~i
ti
fa
:'Y
~'i
?IACE OF FIUNG aL~, ~t Q~'~
_ s~ j~,~ TOTAL s
_ ~ n~=a~
,'.a
v'?ITNES$ my hvnd ot Jacks onvilZe Florida , on tnis,
~
~ *he 13Lh day of J9T1U~3!".f , 19~ - -
Y, ' .
` . - _ _
- ~.GNATUR ~ TITLE ~
j u
c Durant ~ Chief, Special Procsdurea Staff
(N E. Cerhficate of officer ,vtF.cr:red J~ ~ YN t: ~~,;e o~k~~owle•'~n•.e~ts ~s not P;y~nt:sl ~c tbe vol~d~y of ho~~ce o{ Federol Tox i~en G C1/~.
25419; C.B. 1950-51, 125.)
_ ss ~
PART 3-To be used for ~ecording purposes
: c
. _ _ . . 4_.__~. . . .
. . . . . . . . i~ . _ _ . .._e