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Form 668 DEPARTMENT OF TME TttEASURII-INiERNILL REVFNUE SERVKE For Op?wno f6ce
~REV. ~ a» ) CERTWUTE Of ltEIEASE OF FFDBGI T~l( l1EN
~ DISTRICT SERtAI NUMBER .
JACKSONVILIB FLOBIDA 46 2 2
I hereby certify that as to the following-named taxpayer the requirements of Section
6325(a), Internal Reve~ue Code, have been wtisfied with respect to the taxes enu-
meroted below, together with ol) statutory additions provided by Section 6321; and
that the lien for such taxes and stotutory additions has thereby been releused. The
proper ofi~icer in the offxe where notice of internat revenue taz lien was fcled on
Juti@ 29, , 19~_, is heieby authorized to r?~oke notation
on his books to show the release of said lien, insofar os the lien relates to the follow-
' ing taxes.
NAME OF TAXPAYER
Jerry L B~,~t Jer s Blectiical Service
~ RESIDENCE
; 3851 South Federal Hi wa Fort Pierce Florida 33450
~ UNPAID BALANCE
~ KIND OF TAX TAX PERIOD ENDED ~ATE OF ASSESSMENT IDENTIfYING NUMBER OF ASSESSMENT
. la1 (bl l~1 ~d~ ~e~
941 Fiithholding 03-31-65 06-25-65 59-1003189 887.25
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~ FILEO ANC~ EC0~10E0
ST.LUC~E C UNTY f?A.
~ ROC[R ' ~~f RAS
~ CIERI: CtR Uli COURT
RECaR1 VE!' c ~Dr.~...-~-
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PLACE OF FILING
Clerk, Circuit Court TOTAL g gg~.'~
Saint Lucie County
~'s Fort Pierce, Florida
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"`'~,~~t~' WITNESS my hand at JBCksonville, Flotida , on this,
~
~ rhe 28th ~y of November ~ y 72
.
SIG E TITLE
J Chief S cial Procedures Staff
: Certi6cote of officer outFwrized by low to take ocknowledgments is not euentid lo the validity of Notice of Federal Tox Lien G.C_M.
26I19, C.B. 1950-51, 125.) gg
~ PART 3-To be used for recording purposes ~
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