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FOfm 668 DEPARTNtENT OF THE TREASl1RY-NTEITIAI RFVENUE SfRV~CE for Optional Use By RKwdmg OA°~te
~REV. ~a»> CERT~IUTE OF REIEASE Of FEDBtAI TAX UEN
DISTRICT SERIAL NUMBER
163877 B170 P783 2~41~
1 hereby certify thot aS fo the fottdwing-named taxpoyer thc requ+rements of Section
6325(0), Interna! Revei?ue Cocie, have been so6sfied with respect to the taxes enu- '
meroted below, togethe,r.-with. al{ statutory ddditions provided by S~ection 6321; and
tho~ the Gen for such tozes ai~d stotutory odditions has thereby been released. The
proper officer in tiw-.oH'ice where notioe oF inferna! revenue tax lien was filed on ~~~,~NE~
- ianuaiw
2_6 _ , 19~$., is hereby authorized to ntoke notation R P01T
on his books to ahow t
e releuse of said (ien, insofar os the lieo relates to the follow- CLERX ~1R~11R ~T]~ ~
ing toxes. ~ ~FM'~Yr'''FIfL.~r•j:+~ .
NAME OF TAXPAYER ' " ~ o Si ~~~3
'
OR THORNHILL
RESIDENCE r ; 26541'7
P . 0. ~H4X 3441 _
FORT P RCB FLORIUA 334S0
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDEO DATE OF ASSESSMENT IDENTIFYING NUMBER Of ASSESSMEtVT
la1 (bl I~1 (d) ie?
1040 12~31-66 8-04-b7 262-36-5794 1328.24
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~ PLACE OF FiUNG
~ Clerk, Circuit Court TU7Al ;
St. Lucie County 2328.24
t Pierce Florida
wITNESS my hand ar Jacksonville, Florida , on ~,+s,
rhe 20th ~y of September, i9 73 _
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SIGNATURE ~ T1TLE
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' ack Durant Chief S cial Procedures Staff
' (NO : Certifitote of of~icer outhorized by !aw fo toke ocknowtedgments is not essential to the volidrty of Notite of Fede:rel Tox Lien G.C.M.
2641 8 51, 125
3~aK2~~ ~G~~.37~
" PART 3-To be used for recording purpose: gs
rt
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