HomeMy WebLinkAbout1497 .
Form 668 DEPMTMENT Of lT~ TREwA1RY-NiEWAt tEVfNUE SERVICE far Opiaal Use 8y Raordng ON+ce
(~v. 1-701 CERT~IGTE Of REIEASE OF ~DERAI TAX UEN
~iSTRICT SERIAI NUMBER !~~E~~
, J~~~ 2 721 B197 P251 ~;1 I!MCER ~!T
I hereby certify that as to the folbwing-named taxpayer ~he requiremer~ts of $ection O~R~ CIRCIIIT GM1
G325(a), Internal Revenue Code, hove been satisfied with respect to the taxes enu- ~~0 VERIFiEp
merated below, to~ether with all stotutory additions provided by Section 6321; and
that the lien for such toxes and statutory addi6ons has thereby been released. The
pro otficer in the office where notice of internal revenue tax lien was filed on
~vembAY` il , 19 7~_, is hereby authorized to diake notation
on his books to show the release of said lien, i~uofar as the lien relates to the follow-
mg taxes.
NAME OF TAXPAYER
~1~
~ Drr~i 1~i1+i~e i DMdp~
RESIDENCE
14~ 1~~ lS11 8~.,
1re't ~sw~ !"'3a.•33k'~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
la) (bl kl (dl le)
!!~1 6-~-~1 ~0-y-71 S'9-1053T9i~ 1.3~3.~
~I
PLACE OF FfUNG Ci~i~ ~i"~ *
s~ ~ TOTAL j
~lt. ri~a~w~ Tis.
WITNESS my hand or _ Jacksonville~ Florida , o~ rh~s,
~ rhe 6th day of September , 19 ~2
,
$Ol?K ~il~f
SfGN RE T1TLE
; aAt Praced~res S.~d~_ _
(NO . Certificote of offi oothorized by Ivw to take acknowlr'gr.~ent> ~s not essent~ai fo tfie valid~ty of Notice of federal Taz t:en G.C.?A.
9, C.B. 1950-51, i25.) ~C
PART 3--To be used for recording purposes
- - - ~ ~ . . ~