HomeMy WebLinkAbout5171 . _ _ _ . _ - -----T - /G _ _
f~xm 666 oE?w~r?~r oF n~ newwry -s+~~c eevEt~x~ sen~CE ~ For the R«o.d~ OfFc.
(REV. 1-70~ CQT~iCA1E Of REIEASE ~f FEDBAL TAX L@N L{ICI COU
DISTRIGT SERW. NUMBER ROCElI t01TAA: ~
240106 B207 P1099 CIERK CtRCU1T COURT
RECORO YERIfIEO
I hereby c«t~y as ro the folbwi~g-rwmed roxpnyer the requirements of Seclion
6325(a), ~r~l~no~ tt~e~erwe e«k, have t~een sa?isfied with respecr ro the roxes eno- ~M ~ " 20 ~'i~
meroted below. logetF~ with all statutory odd'dions provided by Section 6321; and
that the lien For wch tax~ and stalutory add'dia~s Iws thereby been released. Ths 2rAC~~c
ProPer officer in the ~QA'ioe where notice f ioterrwl revenue tax lien was filed on Ya~lj V
October 1t3, , 19 ~2, is herobr avN~orized fo nndce nototion
on ha books ro show the releose of said (ien, i~ofcr as the lien relates ro the foilaw-
ing taxes.
NAME OF TAXPlAYEIt
~
RESIDENCE -
1~ ~ ;~t 9~'~
UNPAID BALANCE
! K1ND OF TAX TAX PERIOD END~ ASSESSMEM DATE IDENTIFlfING NUMBHt OF /1SSESSAAENT
i (al (b1 Ic? ldl Ie1
~
~
~ 941 ~ithboldiap 06~.'~0~T2 09~?73•?2 ~IlbB~3T 1~00?.t~?
7
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3
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PLACE OF FILING
- Cl~l~C~ L~i'Cidt COYCt TOTAL ; 1~T•~
~s ~C~
i7
WITNESS mr hand at Jac onville Florida , on th~s,
_ ~ Sth ,c ~enuarv 20 73
~ ; ~ , 6ecx ~ ~~~c? 2~.6~
SIGNATU~~ , ~ nnE
- _ ~ ~~i~ -Y'~.r
W J Ke Actin Chief S ecisl rocedures Staff
' (NOTE: Cert e of o~cer~futhonzed by I fo oke ocknowleclgments is not essenhal to the validify of Notice o1 Federaf Tax lien G.C.M.
- 264i9, C.B. 1950-51, 125.~
PART 3-To be used for recording purposes s s
~ °~'T J n" 4
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