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Form 668 DEMRTMENT OF 1NE TREwSURY-TITEevAt tfVEMt~E SERVICE for Op~ 1 se BY Recnrd.y O(Fce
(REV. 1-70) C~~u~ ~ ~ ~~eG~ T~ ~
DISTRKT SERIAI NUMBER • C1RC~It~ ~T,,
~ii~ill~ ~ 243298 • • ' RE6~YlRI~IEO~,\~
I hereby certify ~?at os ro H,e fdlow~ng-nomed roxpayer the requ~remer?rs of Secfion
6325(a). Inte~ria( Reve~ue Code, hove baen sotisfied with respect to the taeces enu-
meroted below, rogett~ with oll stotutory odditions provided by Section 6321; cnd
, thot tht tien for such taxes ond statutory odditio~s has theteby been relcwsed. The 2~~y~
proper officer in tha offxe where notice of intemal revenue tax lien wos filed on
Da.~,embar 7-~---. 19J~, is hereby authorized to dioke notation
on h+s books to show the reteose of said lien, i~uofa~ as the lien relates to the folbw-
ing taxa.
NMAE OF UXPAYER ~ilh 81~R ST
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ssio n
rt rter~ n
• uN~NO a~uNCE
i , KINp OF TAX UX rERiOD ENDED ASSESSMEM DATf IDENTIF1fING NUAABER OF ASSESSMENT
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~ Q41 0~-ii-7= o?-Qi-7= ag-liTSTii i,soi.8d
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~ Pu?cE oF Hurrc '
~ TOTAL s
_ y~ ~,,,3y 1,91b.68
Fcrt Pieros. Florfds
WITNESS my hand at Jacksonville, Florida on this,
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b:1~~s ~:V~ ~1f~f ~i~~
rhP Sth do~ of January 19 73
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SIGNATURE TITLE
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W ned ~ ~ Actin Chief S cial Procedures Staff
1NOTE: C i~cote of officer author~zeJ a o take nck:~owledymenh is not e>senhal to tne vol~dity of Nohce of Federol Tax l.en G C.M.
2G419, C.B. 1950-Si, 1~5.)
PART 3-To be used for recordiag purposes ss
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