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Form 668 oErARrrNErvr oF Mf TRE~SURr-a~frE~t~u eEVENUE SEtvKf Fo. Oprorwl U~e 8r Rceadng d!',c.
(r~v ~-~o} CERT~iCRi~E Of I~LEASE Of FEDQAI TAX UEN i. ~E CO~EN
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; UISTRiCT SERIAI NUMBER ER ROITRA=
J~Q~~tii~ lJ~t~? 209524 B192 P1785 ~t K Cr~CUn~
RECORO YEqIf1Ep~,,,.~,~
' I hereby certify H,at as ro tt+e follow~ng-~amed rox~,ayer ~he ~equ~remenn of Sect~on
6325(a). Internal Revenue Code, have been satisfied with ~espect to the taxes enu- I' n
meroted below, togethet with ull statutory odd'itions provided by Section 6321; ~d u~ it
. that the lien fcr suth taxes and statutory additio~s Iws thereby been releosed. The ~
prope[~o~fl~'ic~r in the oifice where notice4~ nlernal revenue tox lien wos Rled 'on
, ~.Y C~s , 19__i_.~ is hereby outhorized to nloke notation
on his books to show the release of said lien, insofar as the Ge~ relates to the follow-
' ing taxes.
NAME OF TAXPAYER ~ ~
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RESIDENCE 1~ ,~~r ~j
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UNP/11D BAUNCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMEM ~ATE IDENTIFY~NG NUMBHt OF ASSESSMENT
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vrnTlvESS my hand a~ Jacks orivi~ i e~ Fla~id a , o~ ri~a,
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; the~_do~? of March , 1972
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= SIGNATUitE T1TLE
: Cert of ofFxer outhoraed by law ro toke ocknowtedgments is no~ esse ~ to ths voGd~ly of Notiu of F~d~rd Tmc Li~n G.Cli+~
s~ 6419, . 950-S1, 125.) :
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