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~ Frts ~s ' U. S_ TREASIN:Y DEPARTYENT - INTERMAL REVENUE SERVICE Fa Oteioasl Uu Br R~ta~dap OHic~
< «EV. s.bn - CERT~IUTE OF REIEASE Oi iEQERAt TAX ltEN
? DISTRICt • .SERIA~ NO.
~ Jacksoaville Florida 120770 875 P981
i 1 Aa+eby cw~ifp Nwt es to the (ollowinq-noeNd toxpoy~r the rpviaem~~ts of S~etipn
i 6325(0) MtKeol R~wnu~ Cod~, hsw b~n sotisfisd with ~espeet to the tox~s eou-
~ ~et~d b~lew, t ther with oll stotut
o~ ory odditions povid~d br S~ction 6321; ond
t tMt tht lisa for suc6 toxes ond stotutory odditions !ws tl+ereby bea~ r~teas~d. Tht
~ prooer
oH~_ icy i=th~offin wheti notice6Qf Fottrno) revenw tox lien wos fil~d on
_ iwv~e~o~ 15~ '3~ ;s he,~by authorized to moke nototioe
~ on 6is books to shar tht rtkos~ of soid lien~ insoFor os the li~n r~btes to tht
F
foilo~.in~ toaces.
NAME OF TAXPAYER .
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~ RESIDENCE ~
~ 512 p. 14th St. Ft. Pierce Fla.
CLASS OF TAX UNPA1~ BALANCE
~Ta: R~turr Fw~ Na.) PERIOD ENDED ASSESSMENT ~ATE IDENTIFYifVG N~IMBER OF ASSESSMENT
(e) (b)' (r ) fd ) (e)
Inco~e tau dddl 1%1 11-23-62 62-D-67691 406.26
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F PLACE OF FlLING
Clerk, C~rCU~t COUit - TOTAL s
St. Lttcie County 406,26
` Fort Pierce Fla
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~ wiTNESS my hand or__ Jactcsonville~ Flor~da , on th~s,. ;
the 30Lb doy of July , i9 73
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SIGNATURE TITIE "
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= J rant _ Chief. Specia! procedures Steff
MO - Ger :core oF off;cer o„r1,o.;:ed br la,r +o ~oke ocknowledym•.es is not ess~ntiol to tke volidity o( NWie~ o( F~d~ra1 To: Li~n G,C,A~, `
2M 4,..fr.~ 19iP51. 125.) ~ ~ .
PART 3--To be used for recording purpases
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