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form 668 oEPNtiMErrt oF niE nlEAwtr-IME+lWU eEVEN1uE SERVECE Fcr Optiorwl Us By R~oo.~ng OMic~
(r~v. 1-70) ~ERTHUTE OF RELEASE OF f~DQAI TAX l~N
DISTRICT SERIAL NUMBER ~ ' ~ 1~0 4MD R.~C0R
, , f~. WCIE COUMTr ~
~iek~~nrllls t'LeI+M 220453 a197 t2~39 Rp~~R ~QnR~s
I hereby caiify that as to the following-named taxpoyer the requirements of Section I1fC~RD yf it~~ CO{fA
6325(a~, Internal Revenue Code, have been sotisfied with respect to the taxes enw EO
meroted below, together with oll stututory additions provitled by Section 6321; ond
thot the lien for such taxes and statutory odditions has the~eby been released. The
proper ofi'icer in tfie of~
e where notice o# interna) revenue tax lien was filed on ~
DeCerl!! 14 ~ , 19 7i , is hereby authorized to make notation ~3131s
on his books to show the release of said lien, insofar as the lien ~elates to the follow- "
ing taxes.
~tAME OF TAXPAYER ~
. ~L ~nlM~~a~f+o~
RESIDENCE
~ S. !~1 *4• ~
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UNPAID BJILANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~a~ ro) ~c) ~d) (e)
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~ PiACE OF HLING C~~, ~L ~
~ 3L. CrOY~1~ TOTAL ; ~'f~~
lt~. li~ro~~ ~'la'l+d~
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~ Jackaonville, Florida
WITNESS my hand ot , on this,
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the 7th do of J~ , 1972
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SIGNA RE
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e Cbief, Spacisl Procedures Staff
E: Certificote of of6cer authorized by low fo toke acknowtedgments is not esseotiol to the volidity of Notice of Federal Tax Lien G.C.M.
6419, C.B. 1950-S1, 125.) -
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~ PART 3-To bo usod for recordinp purposes
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