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Form 668 ~ oer~t~r~r oF n+e ~r-a~ewu ~W~ ~ sr R~^9 ~
(REV. 1-70) ~~~u~ ~ ~ ~~BGI T~ ~
CiSTRICT SERiAI NUMBER
225638 B200 P1483 ~ . ~PoK ~ ~
1 hereby cerhfy that os ro the following-namsd roxpayer ths requirements of Section ~0
6325(a), Interna) Revenue Code, have been sotisfied with resped M fhe taxes enu'
merated below, togetl~ with all statutory addi6ons provided by Section 6321; o~d
that the lien for such toxes and statvrory additions hes Hiereby been released. The
proper ofi'icer in the office where notice of internai revenue tax lien was filed on XIr• ~O
Ms~rch 15 , 19~, is hereby authorized to make noMtion 241422
on his books ro show the rdease of said (ien, insofar as the lien relates to the follow-
ing taxes.
I~AMIE OF T/1XPAY8t .
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RESIDENCE .
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' UNPAID BAL/1NCE
K1ND OF UU( TAX PERIOD ENDEO ASSESSMENT OATE lDENTIFlfING NUMB9t OF ASSESSMEPIT
j Ial (bl kI (dl Iel
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f~,~'~1 ~/!~'}t 1~1~'ll
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PLACE OF HIING
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WITNESS my hond ot Jacksonuille Florida , on this,
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the lst ~y of Plovember , 19 72
SI ATURE TITLE
~ Chief S cial PRoceduresStaff
OTE: C i~cate of officer au rized by law to take ack~owledgmenh is not essential to the validity of Notice of Federal Tax Lien G.C.M.
26419 .B. 1950-51, 125.) bgC
PART 3-To be used fot retording purposes
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