HomeMy WebLinkAbout1665 . -'1 G
FOfm 668 DEPARTMEfJT OF 7T1E TREASURY-MFQNAI tEVENUE SENKE fnr Oplionol Uft By R~cording OH'ic!
i-~o~ CERTIRUTE Of REI~ASE Of fEDBGI TAl( UEN ~~IN~fL~.
DISTRICT SERIAL NUMBER ~
R ~qit ; u
221016 B198 P809 fLEt~~IR~q1t ~IMT
1 hereby certify that as to the foltowing-nomed toxpoyer the requirements of Section ~E60Rp 1~E111flfe¦..¦¦..~L
6325(a), Internal Revenue Code, hove been satisfied with respect to ihe taxes enu- ~l
meroted below, together with all statutory additions pro~rided by Section 6321; and
thot the lien for such taxes and statutory oddifions hos thereby been released. The
PD~cembeT office where notic~Qf internal revenue tax lien was filed on 24Q521
, 19 1, is hereby authorized to moke notation
on his books to show the release of wid (ien, insofar as the lien relates to the follow-
ing taxes.
NAME OF TAXPAYER
~L~
RESIDENCE
1b0~ ~ort4 ~~b a~wi
lrrt l1+~ad~i~a
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal Ibl lc~ Idl le)
io~o ~2-3~9 T-~.n ~-~-5~~e ~839.1~
~
;
~
~
~ ~
f
f .
i
E
~ -
~
~ PLACE OF FIUNG CLl~~ a~is O~t
: ~ s~ ~ TOTAL S
~
~ ~~e! tl+~r~~ Tl~el~s
~
~
~
>j
~ WITNESS my hond at Jacksonville ~ Flordia , on tfiis,
~ e
~ the 16th ~y of October , 19 72
~ ~ - i
~ - - 600K ~GE ~
SIG URE T1TLE
i
Jack nt N Chief, S ecial Procedures Staff
TE: Cert~f e of officer authorized by !aw to take acknowledgmenh is not essential to 1he validify of Notice of Federal Tax lien G.C.IN_
26419, . 1950-S1, 125.) bec
PART 3-To be used for recordiny purposas
r~ ,,,J~„; _ ~ ~`.a~.~~-~~.~:.
: " ~