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~ fotin 668 DEPARiMFNT OF TNE i~EAA1QY-i?tiElNtAt GE~+EtviSf SE[YICE For Cp/ionol U~s By Recordng Ol~ice #
taEV. 1-70? LER?IRUiE OF RftEASE OF ~DERAL T~l( tlEli
~ DI SERIAL NUMBER sj R GE CFJITRAE
' ~~jL~j . Cl.ERK Cii~CU1T COURT
~ RErpRD vCF.~=tE~....,.~.,.~.
! i hereby certifr that os to the folbwing-~amed taxpayer fhe ~equirements of Section
~ 6325(oj. tnternal Revenue Code, have been sofisfie~d with respect to ihe taxes enu• ~
j merated below, together with ail stotutory additions provided by Sedion 6321; and ~ ~8 I iv PN 73
! that the lieo for such taxes and statutory additions has thereby been released. The
~ pcnpe` oi~'~t~r in tt~s- ofRce where notics of intemd reve~ue tmc iien was filed on 2~~~5
; Septeuber Z.~ , 19_.Zl, is heroby authorized to r~?ake notation
on his books to show the release of said lieo, insofar as the lien relotes to the fotlaw-
i ing taxes. -
i NAME'Of UXPAYE~ •
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! RESIDENCE ~
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' UNPAID BALANCE
~ qND OF TAX TAX PERIOD ENDED /15SESSMENT DATE IDENTIFYING NUMBER OF ASSES'SMENT -
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~ WITNESS my hond at lsckwonville, Florida , on th~s,
~ the_12Lh_day of June , 1973
SIGNATUR , T1TlE
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( ~6cote of olficer outhorized by low to toke ac4nowledgmenls a nd eueotid to N~e roiidity of Notice of Federd Tme tien G.C.AA.
2 . .B. 1950-5T, 1?i.) ~ ~ e~,~
~ 500!( ~1~~AGf ~
PART 3-To b~ us~d fw ~eordi~p pue~wses
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