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~ Fotm 6b8 DEPI1RiMENi OF iHE TRE/~1f-NfFItNAI REYENUE SE~VI~E For Oplionoi Ute By Recording Oll~icr
' ~REV. 1-70) C~~A~ ~f R~~ ~~~A~ T~ ~
DtS7pR SERIAL NUMBER ~8
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, . J • C~E~c C~xe~T t~M~ .ci~
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I hereby ce~tify that as to the following-nomed taxpayer fhe requiremenh of Secfion
6325(a), internol Revenue Code, have been safisfied with respect to the taxes enu- pV
merated below, together with oll statutory odditions provided by Section 6321; and a7 i~
j tFwt the lien for such taxes and stabtory addifions has tF~eby been releosed. The ~0~ b
' proper otfxer in the oH'ice where notice of inlernol revenue tax lien wos filed on
March 9 , 191~, ~ h~ebr a~~hor~:ed to rri~ke ~orotan
on his books to show the rdease of said lien, insofor us the lien rclates to the follow-
ing toxes.
NMAE OF TAXPAYER
~ ~ ~
RESIDENCE l~ ~k ~f"~
~'R~. PLl~~ )1.
UNP/UD BALANCE
~ KlND OF UX TAX PERIOD END~ ASSESSMENT DATE IDENTIFYING NtaMBBt OF /ISSESSI~AENT
~ b) 1~1 kl ldl t•1
i
i
t io~o ia.~-7o 5-~-~ ~-~6~-?~7 ~.~5
~ _ _
;
. ,
~ ' ~?cE oF Aur~
~ (~erk, C~rG~it GOw~ TOTAL ;
~ ~t. LuC» Cae~nty
~ f ort P~. ~lond~
~
~ WITNESS my hand at Jacksonville Florida , on this,
~ 3UOK~~
thelst day of November , 19 72
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SIGN URE T1TLE
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( E: Cer cote of offcer ized by law to toke ocknowledymeots is not essential fo the validity of Notice of fedaal Tax lieo G.C.M.
6419 . . 1950-51, 125.~ ,
PART 3-To be used f
be~€ording purposes
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