HomeMy WebLinkAbout0825 Forw bbs U. 5. TREASURY DEPARTMENT - u+TErttut REVEHUE SERV~CE Fw ON~one~ Us~ By R~c«d~p ON~c~
(RE V. 8~67) tERTIFICATE Of RELEASE OF iEDERAI TAX IIEN _ FILEO ANQ RECOR9E~
DISTRICT SERIAI NO. sT ~~E COUNTY ~
RQCf R F~iTRAS
171 1 4 CtERK i~~.CUIi COURT
1 hereby c~rtify thot os to tbs foilowing-nam~d ?oxpoyer the ~equirements oF Section RFCC40 V:Q FiED
6325~a), Internel Revenue Cod~, hove been sotisfi~d with respect to ths taxes tnu-
meroted b~low, together with oll statutwy odditions provided by Section 6321; and ~ f 3 IO 39 AM ~r1
tha? the lien for such ta;es and stotutay odditions hos thereby been releosed. The
proper officar in. the offic• where notics of internal revenue tox lien wos filed o~
~CtOb~! 18_ , 19 6g . is h~reby outhori:ed to mok• nototion
on his books fo show th~ ~elease of soid li~n, insofor os the lisn relot~s to the
followiny fo:es.
NAME OF TAXPAYER
RESIOENCE
j0
CLASS OF TAX UNPAID BALANCE
!Tax Return Form No.) PERIOD ENDED ASSESSMENT UATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) (b ) (c ) id ) 1
lArbo L3-j1~-~67 ~ ~13-~4-1bZ1 6,51+~.3L
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~ PLACE OF FILING
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~ Gi.~i1C, CIRCUI? OOUB? TOTAL S GlS14•3~
~AiNT ~.IiCZ~ OOUI!!~~ E'I~t3~
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5~~%
~sE~ WITNESS my hond at Jacluom?ille, Florida , on this,
~2
80U!( ~O~ PACf O~~
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~~k rhe 7th day of Junt. ~ ~q 72
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~ SIGNAT E
Ju r Chia f, Special Proc~dure• Staff _
(NOT ertilicot~ ol olfic~r outhwixed br law e~ toke ocknowledqmenrs ~s ~ot ess~nriol to tM volidity of Notice oF Fed~ral To: Li~n G.C.M.
9, c.e. ~vso-si, ~zs.~
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PART 3--To b~ us~d for rocordin~ purposa ~
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