HomeMy WebLinkAbout2070 ' Fortn 668 OfPR@T.NENT QF T!ff TlEA$URY-+}
~TfHJAI YENUE SERVICE Fo. Oprwno! Use 8y Recn?dng OII'~ce
~eEV z-~o~ tERTWUTE Of REtEASE Of fEDBGI TAX UEN ~
DISTRI~T SERIAL NUMBER ~ ~
~ J~~~i 217959 8196 P2221 R~ ~ ,~`y~
I hereby certify that as to the following-named tazpayer the requirements of Section ~~~~i
6325(0~, Intemal Revenue Code, hove been satisfied with respect to the taxes enu-
meroted below, together with all statulory additions provided by Section 6321; a~d ~ 8~~
Hwt tha lien for such toxes and statutory additions hos thereby been released. The
proper ofF'icer the f~ice here notice o ternol ~evenue tax lien wos filed on
~ovem~er , ~9 ~~is hereby authorized to Make notafwn
on his boo0cs to show the release of wid lien, insofar os the lien relates to the follow-
~ ing taxes.
NAME OF UXPAYER 9~1 C i~; W~
i RFSIDEPlCE ~ s
! ~!t P~lO~ ~ ~
j UNPAIU BALANCE
~ KIND OF TAX TAX PER}OD END~ AS.SESSAAEM DATE IDEM1F1fING NUMBER OF ASSESSMENT
i b1 ro1 kl (d1 NI
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]~0~0 3~.~To 3-~ ~3-~3~2 ~.b3L.3o
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~ RACE OF NUNG
Cfgrk. C:ittu~t Co~Xt TOTAL s'f
St. ~lIC90 CC~~Y
Fcxt P~rcE. Fkxttia
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1MTNESS my hand ar Jacksonville, :~ori~a , on M,~s,
_ the 1 h day of j~~h , 19 72
_ l
SlGNATUR TITLE
= an Chief, Speci al Proceciure s Staff -
=';s E Ce.h~cote ef offce. author~zed by :aw to +ake acknowfedgments ~s net essent~ol to the vobd~ty of Not~ce of Federa! Tox !~en G.C.M.
_ ?64~9. C.B. i950-_`1, 1251 S9 ~
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PART 3-To be used for recording purposas
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