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Form 668 oE?NCr?dEPIT oF iF1E TiEw9uett--NiE1Q+At ~V~IIE SERVICE fnr Op~iorod lhe R ON'ic~
~~Ev ~-~o~ CQTlItATE Of R~EASE OF ffDBGI TA~ 1#t~l tE CouN
DiSTRICS SERIAL NUMBER ~ 06fa POITRAS
' 223438 B199 P1381 ~ CLEIIK C~acviT COU~T
IIECOP.D VE~+fIE~
1 hereby osriify that us b the following-namsd Mxpoye~ fhe requiremeots of Seclion
6325(a), Inlerno) Rsvenue Code, havs been satisf'ied with respect to the faxa enu- ~ 13 Z~ PM ~~Z
merated below, together with all statutory additioos provided by Section 6321; and
that ihe lieri for such taxes and statutory oddfions has tl~eby bean roleased. The
proper oAioer in fhe oMice where notioe of internd 236200
F_b +Arv 8_ , 19_..1~, es hereby ouThorized ro'rtwke nototion
on his book: ro show the release of said lien, insofar as the lien relates ro the follow-
: ing Mxes.
NANiIE OF TihXP1~1Y6t
~ ~~i'
~ UPIP/UD BAL~INCE
~ qND OF TAX T/1X PERIOD ENDED ASSESSAAENT DATE IDENTIFlfING NUM68t OF ASSESSMENT
(a1 lbl k1 ldl lel
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~ ~ 3010 Z+ro~r l~•~i~ Ot•iil•il 11i Lt ~ S ~3
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` 1~i9 ~tr~r ~ O~tt~71 ~i ~i ~ =aiM+l~
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~ PIACE OF FlUNG
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~~t TOTAL ;
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WITNESS my hand at Tacksonville~ Flor da , on this,
the_2~,II~_day of A~~ust , 19
S!G TURE TITIE
Chief S cial Procedures Staff
~ 1NOTE: ificate of~~er autharized t~y low ro toke acknowledgments is ~01 euentiol to the validity of Notice of Federal Tax Lien G.CJM.
T . C.B. 1950-51, 125.)
PART 3-To be used for recordin~ purposes S$
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