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•Form 668 DEMlTMENT OF iME TRFI~SURY-NTERNAI REVENUE SEMCE Fw Opfionol Use 9Y Rtcordng Of~ice
t~v ~_~o) CERTWUTE OF REI~ASE Of ~FDQAI TAX tlEN ~~~~'~oowlT~r~
DISTRI~T SERIAL NUMBER
218722 B197 P252 l~lEltx CiR~
~T `
I hereby certify that os to thc folbwing-nomed taxpayer the requirements of Section ~R~F~.r~,~
b325(a~, Interna) Revenue Code, have been safisfied with respect to ihe taxes enu-
meruted below, together with all stotutory additions provided by Section 6321; ond
that the lien for such taxes and statutory oddfions ha~s thereby beea releosed• The
~ proper ofFicer in the ofFice where notice of inTernal revenue tax lien wos filed on
19~_, is herebr authorized to Make notation ~
' on his to w release of wid lien, insofar as the liea ~elotes to the follow-
ing taxes.
NAME Of T/U(PAYER ~
m~~a a. ~a~t,
: RESlDENCE ~ ~
~~N1 ~
UNPAID BALANCE
' : KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
( (a) l~1 k1 (dl (~l
f
` l1~1 7~0-A)~ ?~"09 LO-3~T1 5 ~-A l,~Q.!!
~ .r ~s
~ ~..~t~r
a ~ ~n
~ tia. 8~i
~
~
~
~
z
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PLACE OF FILING Q~pk~ ~S Q~1
s~. L~ C~t~ TOTAL s =t~~~
li. na~w~ ~'l+t. .
r
~.'VITNES$ my hond at Jacksonville, Flo~ida , on th~s,
'r,
~R
the~_day of I~rch 9 72 -
SIGNATURE T1TLE
Jac - Chief, Special Procedures Staff
T` { E: Cert~f,c of of~'icer ou~ho zed br iow ro take dnow~edyments ~s no~ rsential to tFv: validity of Nohce of Federat Taz lien G.C.M.
._;~-=7 2 I19, C.6 SO-51, 1~5.)
=s PART 3-To be used for recordin~ purposes
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