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Fenn 668 U. S. TREASURY DEPARTMENT - mTErtN~~ ttEvENUE SERViCE Fo. Op.,o~,e1 Use Br R««d,~.q OFI,c.
(REV.&671 CER11fICATE 0~ RELEASE Of fEDERAI TAX l1EN ' ~
DISTRICT • ` SERIAL NO. ' ~E~ ~ • `
J~ 199261 B187 p1350 ~l~kK Ct~CUIt Cv1l~~
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i hereby tertify thot os to the (ollowing-nomed taxpoye~ ths requirements of Section
6325(ai, (nterrwl Revenue Code, hove been sotisfied with respect to the tozes enu- ~~~u
meroted b~low, together with all stotuto~y odditions provided by Ssction 6321; ond fl
tF?ot the lien for such loxes ond stotutory udditions has ~hereby been relecsed. The
. proper officer in the o~fice v~,here notic pf i~ternol revenue tox lien wos filed ~ 24~q3~
OCCODl2' L ~q ~
L ;s hereby outhorized to moke nototion
on his books to show the releese of soid lien, insofo? os thc lien relotes to the
(ollowin9 fcxes.
NAME OFTAXPAYER
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RESIDENCE
Rt 2 ~oz 1119
1~01t~' p !L
CLASS OF TAX UNPAID BALANCE
iTax Return Form No.) PERIOD ENDEO ASSESSMENT DATE IOENTIFYING NUMBER OF ASSESSMENT
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~ Jacksouville, Plorids
° WITNESS my hand ot , on this,.
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~ ,~1e 28th d~, o~love~ber ,19 72
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S~GNATU E TITLE
~ c a Chief S~ecial Procedures Staff
~ ~N E: C ~ficare of o(ficer ~:e by to toke ocknowledgmems is not essem~al +o +he vol;dity of No~ice of Federal To: L~en C.C.M.
2 .B. 1950~51. 125.) ra
~ PART 3-~To be used for recortiin ur oses
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