HomeMy WebLinkAbout1498 Form 668 U S TREASURY DEPARTMENT INtER~~~; P£vEr+uE sE~: ~CF Fw Ov~•d a~ Us~ B~ Reco.d•~y W~ ce
R E V. 8-57 ^ (ERTIFICRTE OF REtEASE Of ifDERAI TAX LIEN_ ,
~ISTRICT SERIAL NO
_ J~p~~~ ~'y~~~ ~59654 B1840 P295__ ~~Ap01TRAi"''
1 hereb. ~ertify thot as to the lollowing-named toxpoyer t~e requ~rcments of Sec~ia+ Q~~R CtRCY1T COtIRt
h325(n!. ;nter~ol Revenue Code, hove been sotis(ied w~tti respect to the taxes cnu- ~~~~yE~f~~~
merated belo~, toge~her wifh oli stotutory odditions prov~ded by Section 6321; ond
thot the lie•~ for such toxes and stotutory odditians hos rhereby been re!ecsed. The
proper officer in the office where ~otice of internol revenue tox lien was E:led on
_~gp~ember ZZ , 19~_, is hereby outhorized to mokc notat~on ~j
o~ his books to show the releose of soid lien, i~soFor as the lien relotes to the If~rt)Q~~
following faxes.
NAME OF TAXPAYER
~i~ Ci• ~~e
RESIDENCE t -
~ 001~'~r
S~ ~'Lri+dia
CLASS OF TAX UNPAID BALANCE
?ax Return Form No.l PERIOD ENDEO ASSESSMENT DATE !C~ •TIFYING NUMBER OF ASS:SSMENT
!o ) ~b ) (c ) !d ) ~
I ~ ~~1~
~ 9b1 ~-~1-6A 4- 1~-69 59~l~yoo~b
9b~ 3-31-~9 Lo- 3-~b9 S9-l~yo0~6
~i_ACE OF FILING ~~y ~S - -
:
~ vr~a~y
~N SL~ L~~ C~ TOTAL S 9~~u
~ ~d~'~r n~~
~
x
~ TN ES$ my hand ot ia kaenvi jl~_E1 ~,ri rt~ on thi s,
• ~.e ~?LtL-dQy of ~~tember , 19 7~ -
~NA7URE ?ITLE
Jac '
'N : Ce-ri+' e of officer ou o~ y low +o roke acknowled9ments ~s ~o+ essenti ~ ro r~,e ~ol~d~ty o otice of e ero Tox L~ er G.C1N.
6d19, C. . 95o-51, 125.)
~C
PART ~To be used for recording purposes
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