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Fote~ 668 oEPNtTMetST Of l~+E ilEwSl1RY-NiEWAI IIEVHrt~ iHN1CE For Br R~cordng O/kr
(~v. 1-70) CHIT~IUTE ~EIc~SE QF f~D~AI TAX L~N
D~STRlCT SERIAL NUMBER ~ PWT~
~ 197 P2363 _ K ~ ~ •
p YERIF1EOr.~+~ ~~(,l~
I hereby certi that os to the following-named toxpoyer the requirements of Section
6325(a~. Internal Itevenue Code, have been satisfied with respect to the tuxes enu- SL ,~~~3
merated below, together with all statutory addtions provided by Section 6321; and
that the lien for such taxes ana stotuMry additions hos thereby been released. The `Z~S68
t proper officer in the ofi'ice where ~otice Qf inl~ernol revenue tox lien was 61ed on
December 8, , 19 ~1 , is hereby outhorized to make notation ~
on his books to show the release of said tien, insofar as the lien relotes to the foltow-
ing taxes.
NAME OF TAXPAYER
~'ii ~i. ~~a
RESIDENCE
t76i ~.t.4L ~w. • /2~
UNPAID BALANCE
I KIND OF TAX TAX PE(~OD ENDED ASSESSMENT OATE IDENTIFYING NUMBER OF ASSESSMENT
~ Iol (~1 kl ld1 lel
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~ 9i1 Of-~l•i~ ~•70 S~!-l~lail i3t.72
~ 9~?I 0~3-31-6~ 0~•2i-d! '!-ltl~Sl 3,~
' 9ai 0~10•N 10-a3~-i~! !i!-ill~231 l.~ll.~
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' WITNESS my hand at j,a~l~annvi 11 ' Flerida , on this,
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E~ the 1 Rth doy of 7anuarv , i9
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SIG RE T1TLE
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( E: C~ ' ote of officer ou ized by law to take acknowledgmenh is not essentiol to the volid"Ay of Nofice of Federol Tox l~en G.C.M.
°a" 6119 . . 1950-51, 125.)
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~ PART 3-To b~ used for recordin~ purposes
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