HomeMy WebLinkAbout0819 Fom~ 668 DErART~AErrf OF 7NE nlEASUK-~lTFOJAt REVE!!UE SHNCE For Opionol Use Sy R~mrdrg ORic+
~REV. 1J0~ C~CATE Of RQEASi OF ~O~AI tAX t1EN
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D{STRICT ' S6tIAl NUMB~t R CE~ POITR~3
T1~e3~i ~ 19 P2840 6iERK C~~:~UIT ~OyRt
4R~ Vr"R ~:EO
I hereby certify that as ro the folbwing-~amed taxpaye~ the requi~ements of Section
6325~a). Inlernal Revenue Code. have been safisfied with respect to the taxes enu- ~o ~
meroted below, rogether with all statu~ory add'~tions provided by Section 6321; and
thot the ~lien for such taxes and statutory addifions has thereby been releosed. The
proper off'icer in fi'ice whe~e notice ~nhrno) revenue tax lien was 6led on
9~, is hereby authorized to moke nototion 231316
on his books to show the releose of said lien, insofar as the lien relates to the fot{ow-
irtg taxes.
NAME OF TAXPAYER
.
~+~YMe'
RESIDENCE t•~ ~ .
~rors rl~rN~ !'L~'ii~-~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
ial (~1 1~) td) (e1
~ 9i~1 9-30-ri u~6-Tl S9~-~1~l~ 959•~
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~ P'~ACE OF FIIING
~ 3ti. ~ Ci11~~ TOTAI S ~9~~
1't. TifrM~ t1a.
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~ ~v'iTNE55 my hond at lacksonville Florida , on ~,~s,
~ E~R~ 203 ~i~~ ~~8
~ the Tth da of Ju~ , 19 72
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L= ~GNA TITLE
~ ChLsf Special Procadurss Staff ~
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Ju rant
~ (NO . ertificde of of5cer outl?oraed by bw to take acknowledgmenh is nd essentiol to the volidity of Nofice of Federol Tax lien G.CM
9, C.B. 1950-S1, 125.)
~ PART 3-To b~ us~d for nco~+dfn~ pvrpos~s s•
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