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' Fotm 668 OfPARTMENT OF THE TREASURY-NTE~tAI REVENUE SENKE ~ For Opfionol Uie 8y Reco.drg OIFce
tREV. ia~i1 CEltTIRUTE Of REIEASE OF FEDERAL TAX UEN
~ DISTRICT SERIAI NUMBER
Florida Book 18 Page 312 ~
1 hereby certify that as to the following-nomed taxpayer the requirements of Sect':an
6325(a), Internol Revenue Code, hove been satisfied wilh respett to the taxes enu-
merated below, together with all stotutory odditions p~ovided by Section 6321; and
that the lien f~r s;;:.h taxes and statutory additions has thereby been released. The
proper offi er in t~ offic where notice f internol revenue tax lien was filed on
~eptember g3, , 19 6~ , is hereby authorized to niake notation
on his books io show the release of said lien, insofar os the lien reiates to the follow-
ing taxes.
NAME OF TAXPAYER
Johnnie H. Henderson
RESIDENCE
UNPAlD BAIANCE
KtND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTl:-1fING NUMBER OF ASSESSMENT
(a~ ~b) k~ ld) le)
~ Excise Tax 1/158 - b-30-5 10-7-bQ 6J-10-355001 432.67
k'.H. ~2-3I-b0 3-3-61 E1-3-16b711 I 57.58
~ W.h. 3-31-60 5-5-61 61-5-165088 161.33
~ Bxcise Tax 12-31-6~ 7-7-61 61-7-350001 25,47
Excise Tax 3/31/61 7-7-61 61-7-350Q00 38.52
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PLACE OF FtLING
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~ Clerk of the Circuft Court
~ . Palm Beach County TUTAL $ 715.57
~ West Palm Beach, Florida
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~ Jacksonville, Florida , o~ th~s,
WiTNESS my hand at -
~
~ ~e 7 th day of ~ovember ~ 9 72
~ / .
SIGN RE T1TLE -
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4 ~ " Chief, Special Procedutes S~aff
t. Certificote of officer outhor+zed by law to toke oc.k,~owledgments is noi essentiol to t R a rvo:ica o~ Tox lien G.C.M_
~ 9, C.B. 1950-51, 125.) ~a~K~.rV~.~
PART 3-To be used for recording purposes G`
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