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Form A68 U. S. 7REASURY DEPARTMENT - v+TErr~+s~ rtEVENUE SErtvKE Fa Oyr~aal Use 8~ Re~ordu~q Wf~ce
iREV.B-67) CERTIFICATE Of RELEASE OF iEDERAt iAX LIEN u~?yo
DISTRICT SERIAL NO. ~~p ~j~s ~ ~~'l
865 B187 P2194 K CiRCYR L~T 1
JACYSt~iYILi.~ 199 ~I.ER
1 hereby ce?tify thot os to the following-nomed toxpayer the ~eQuirements of Sect~on ~E~~ yEP'~~~~
6325(0), Interna) Revenue Code, have been sotisiied w~tl+ respect to the taxes enu- ~
meroted belo.v, together with oll ztatutwy addit~ons provided by Section 6321; end p~ I5 ii oi AM ?t
thot the lien For such taxes and stotutwy odditions hos thereby been relecsed. The
~ pfficer ~r~, the office where notice ~nternal revenue tox lien wos filed on )
~a~oDfr ly , ~9 is hereby authorized to moke notution /~r4Q522 .
on his books to show the releose of soid lien, insofar os the lien relotes to the
followeng foxes.
NAME OF TAXPAYER
JOi~DDiI~ H. & F.Z.I~JUlOR IiF:YU~:L~
RESIDENCE
P. 0. BQZ 1112
FOEt? PZ:RGt FL.
ClASS OF TAX UNPAID BALANCE
iTox Return Form No.) PERIOD ENDED ASSESSMENT UATE IDE~`+TIFYING NUMBER OF ASS~SSMENT
(o ) (b 1 ic 1 (d ) ~ (e )
i ~10 Q~Z.iC~7~ 16J"~Id'~~~ 1>~17~7iZ
I
~ lot~o 12-31-66 ob-12-?0 265-++.~-S15g 427.33
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~
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PLACE OF FILING
~ CLi~[, CZ1iCUI? (:(llJh?
~ .~.T. LUCIL ~'~x'~ TOTAL S Z~~T~OS
~ PtrRCE, FI.. -
~
~ TN ESS my hand at Jacksonville , Florida , on th~ s,
~ F~uK~V~ PAGf~~
~ the 20th doy of October , ~q_ 72
~ .
SIG ATURE TITLE
+ ~ ~ Chief, Special P~ocedures Staff
TE: C ificate of er outhori:ed by law tc ro4~ acicnowledgme.+~s ~s not esse~t;ol ~o the ~olidity o~ Not~ce of Federol Ta• L~en G.CId.
z~s~i9 _B. ~9so-s~, zs.? bg~
/ " PART ~To be used for recording purposes
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