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Farm 668 o~nrcTa+ern oF n~ r~wwn-wrfaruu ~ue sfcnce ro. op~orw~1 us ey R.~oni~ of~ce
lREV ;-70) CERTiRUTE OF RELEASE OF fE08t!?L TAI~ t~ ~fn;~D +tftiot~
DISTRICT SERIAL NUMBER ~ER
FO~t ~
225168 B-200 P-864 ~ ~ERx Ci~Gfi~t COIIRT
i hereby ce~fy ~har as ro ~he follow~r~g-nar~ed roxpoyer ~he requ~~ements of Section ~toao vER~f~EO~.~
6325(at, (nterral Revenue Code, have besn satisfied with respect to the toxes e~w- ~~2 p~
merated below, rogether with all statutory additions provided by Section 6321; and ~A
tFwt the lien for such toxes aad statutory oddifions has thereby been released. The
~er ofFicer in the off'ice where notice of intemol rever~ue tax lien was 61ed on
~~~Iarch 9th , 19~~ is hereby authorized to moke noiration 2~14
on his books b show the release of said lien, insofor ds the lien relates ro the fdbw-
ing taxes.
NAAAE aF TAXFi~YEIt
1W~d C. ~i~i~~
RESIDENCE
~wts ~t L~
UNPAID BAUWCE
KIND OF UX TAX PERIOD ENDED ASSESSMENT DATE 1DENTIFlfING N'JM66t OF ASSESSAAENT
' la1 rol k1 Id1 tel
i .
~ Warei~ f~ I0•3~64 os 0~-Zl•T2 i9~13~l400000 d~e 26-2 i ~l,SS4.6S
l L~-?~ll
~ ,
~
~ ~a~ori~ at.~p ~ o~ OQ~-29-7~ ~ ti~ lIS.00
~
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~ PLACE OF FILII~lG
~ C~~ Cf~ft O~t TOTAL s
~9~69d.6S
~ p~s ~
~ Jacksonville, Florida
u' WITNESi my hand at , on this,
~
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^ ,h2 ?r.d d.,y of February 19 73
~ ' '
~ S~GNATU~iE T1TLE ~ ~ i~l~~
~ yz ~
~urar.t Chi~~~[~ -cial Pro P(~I1TPS Sraff
(N tet~;frcote of oH~ce~ autherae•i by lavv to taie acknowledymen2> is not esse.-~siat to the v~I,d~ty of Notice oF Feder~l Taz lien G.C.M_
2ed19, C.B. 1950-51, 125.1
PtiRT 3-To be used for recording pvrposes
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