HomeMy WebLinkAbout2581 . - - . _ _ - - - - -
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form 668 . aeP~uT,+~rrr oF n~E n~wsunr--aatES?~ ~vax~ seencF 4~0+ sr ~
' lREV. 1-70) ~~T~A~ ~ ~ ~ ~ ` - - .,,,,~,r .
' DISTRlCT ~ ~
; 199258 8187 P1347
~ 1 hereby certify ~,or as ~o ?he fdbwin~rwmed ra~ayer ~he requ"aane~+rs ~ Sec~on ,-r--
. 6325~a), internol Reve~ue Code, hove been sotisfed wilh resped fo the 1~oe.'s enu-
merated below, together with all stotutory add'itara provided by Sedion 6321; ad
that the lien for such toxes ond stahrtory addit+o~s has thereb~? bed+ relea9ed- The
' proper o er i the e where no f intanal revenue lauc liea ~was Ned on ~O
~cto~er ~ ,~tql8 , is heteby outhor~zed fo a+ake .wMa+;op
on his books to show the releose of said lien, insofar as the tien relal~s ~o d+e fdbw-
ing toxcs.
NAME OF TAXPAYER ~
RESIDENCE
~ ~ f~~
~t
tI~AD BALAt~CE
KIND OF TAX TAX PERIOD ENDED ASSESSAAENT DATE ~B~VG M1M~ O~
lal rol k1 ~1
3~o1r0 3r-3L•6S 1~-~''~ ~ ~-~i~-+~i~i ~•n
~
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PCACE OF FILING Cl~,k~ Ci~~s ~
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st. y~~ ~r~tl fOV?t S 1r~6•9S
I+o~t !l,~,e~, ~i
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~ WITNESS my hand at Jacksonville, FlOrida , on fhis,
~
~ the 20th ~y ,~f August ~ ~q 73
~
SIGNATURE nT~
~ Cl C,~i C c L l-s t~
Jack Du Chief S ecial lrocednres Staff
~ ,
(NOT Ce~iifcote of oEiicer o~thonzed by law eo take ocknow~~ts is c+oR ~serdwi to ti.e w1~f oF t~cn d fedesd Toa l+en G_CJMI
2641 i950-51, 125.)
~ p R _ 2572 PART 3-To be vsed for rcco~d~g pwposas kda
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