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Form 668 o~r~t oF tt~ ~ww[r-a~r~w~t ~ san+cE Fo. qprio~d th. M R.oo?d~ olRc~
(REV. 1-70) ~~~~A~ ~ ~ ~ T~ ~ - -
DISTRICT SERU1l NUMBEIt
dacks~rmill,e 206867 8191 P962 .
~ I herebr ce~nfy ~har os b ~he fdbw~n~-nomed roxpayer rhe roqw~h of Sectan 'Ifr. [~p~~f~p IItI~
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~ 6325~a). Internoi Revenue Code. Iwve bee~~ sotisfied wifh resped ro the tmces aw-
meroted below. Iogell~ with all stattrtory ad~lions provided b~? Seclioe 6321; ar~d CIERK~CiRC{~i~T~tRt
~ that fhs lien for such toxes and staivtory addfions hos tMrebY beae roleosed. The PECOP,C YER;FtEO~..,.....r .
: proper oi~ i oti'ioe where ~otice mtemel ~avenus tax lieo wos filed on :
Mal`ch ~0. , 19~, a heroby authorized ro ~e nototion ~ ~a ~ ~ ~
on his books ro slww ths releose of soid lien, insofar as the lien relabs ro the follow- ~i
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NAME OF TAXPr1Y6t ~
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RESIOENCE . . .
1607 S. 26th street
Fort Pierce Fla. 33450
tN1PA1~ BALMICE
; KIND OF TAX UX PEWOD END~ ASSESSMEPIT DATE IDENTIFYING NUMBER Of ASSESSMENT
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; id~o i2-31-69 oi-29-7i l~00-4o-6o9i 43.12
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~ ~ ~.ACE Of R~~NC~
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~ Clerk ~ Cir cuit C ourt TOTAL s L~ 3.12
St. Iuc ie
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WITNESS my hand at Jacksanvills, Florida o~ th~s,
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- the 17~ doy of ~'~ch , l9 ~
SfGNATURE 11TLE
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~ t~ief, Sgscial Procedures Staff
: Cert~ficate of ofFicer autlwrized by law to toke acknowledgmenh is not asenrioi to the vofidity of Notice of Feduol Tox Lien G.C.M.
~ 26419, C.B. 1950-51, 1T5.)
PART 3-To b~ used for recordin~ pu~posos
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