HomeMy WebLinkAbout1058 _ . . . _ . . . - . .
~ ! ~
; , NG ~
~ ~ ~ _
' o~r oF ~?+e n~?wer-a~wru~ ~va~n~E s~ rw op~w~o+ u,. sr e.co.d.g oA~r.- ~
i F,orm 668
i (REV 1-70) ~ ' , ' ~QT~~~ a' ~ T~ ~ 'C rt ~
i DISTRlCT SEWAL NUMBBt
2Z !E C
RC
f . . . . ~ t ~
~ t hereby cefify that as b`ii~e folbwmg~namsd fcxpaysr ths roqwr~ts of Sedwn RE~0~1a V~R~FI_ ~1,~;~ ~
; 6325(a}, IM~anwl Revenue Code~ have 6ean sodisRed with respsct io the toxes enw ~
; n~emted' below, bge~ with all stadutory cdd'itiora providsd b~r Ssctia? 6321 j~d .
that ths 1'~en for such taxes ond statuton? edd'iiia~s has Hbreby l~ea~ roleossd. The
propsr oltioer in ths olHoe where ~otice of iMernal r+e+?anus rox lisn was .filad on
. ~ 12 - . 19_2Z.., a her+eb~r oulhorized ro ~nake notation ~ ~l~~~~ .
on his books ro show the releass of said I'ien, i~ofar as the lien rdales M the fdlow-
i ing Mxat. ~ ~ -
? IVAAAE OF TAXP~1Y6t
~
; -
t j .
~ ;
7 ~nf1f?~`! • .q
RC~(~{,.G ~
( ' F
, ~ ~ ~
f ~
( _ i
~ UNPa~ BAUNCE
i KIND OF U1X UX PERIOD END~ ASSESSMENT DATE tDENTIFlfING NUM66t OF ASSESSMEM
! (a1 rol kl ld) le1 ~
. ~
~ !~i ~a ~ir ~ !l•~M~'1! ~ ~3i
~
!11 ~1 Oi~•~l 3~iMM~ °
i !~t !lr~0•i~0 ~Ti ~•~Miip 13.~
j i :
; ~ 1i1 ~b•~0•~~d ~ ~Oviiiio iu.i?!
~ -
~
,
~
~ , -
f
!
i
i .
~
E
E
F
f
~
PIACE OF FlUNG
; P?~f C~ ~ TOT11L S
, ~s IAI~i
e
l
F
WI?NESS my hand ot Jacksonttillt. llorida , on this,
~
~ 21at , 19 w~~
~ tfie doy of
~ ~
~ SIG TURE TITLE
ack Chi ! a f
( E: Certi6cote of ofl'icer authorized by low ro~oke ocknowfedgmenh is no1 euerdid /o the volidily of Nofice of Federd Toz lien G.C.M.
6119, C.B. 1950-51, 1~5.)
i~
PART 3-To b~ us~d for ncordi~q Pvrpos~s