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Form 668 ' oEVNtTMENT oF t?+E itE~SUCr-wrEttrut ~vEr+uE 5fe~riCE far Opr~ono! Uae 8y Remrd~ng OA4ce
(REV. 1-70) t~~u~ ~ ~ ~~~G~ ~ .
OISTRICT SERIAL, NUMBER - FiLED AND R~~
~ ~y~ 207201 B191 P147S ST~ RocE
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1 hereby ccrtify tho~ as to the following-named taxpoyer the requirements of Section ~«RK CInCU1T COUitT
6325(0), Interno) Revenue Code, have 6een sotisfied with respect to the taxes enu- RFG~R~ YER.. IEO.,.~.,..~~
merated bebw, togethe~ with oli statutory vdditions provided by Section 6321; and s
that ifie lien for such tuzes and statutory additions har thereby been releosed. The Oc~ 19 12 23 PM 73
proper officer in the ofPxe where notice of internal revenue tax lien was 61ed on
^e~ril 8 , 19~~, is hereby authorized to rtiake notation ~
on his books to show the re(eose of said lien, i~sofar ns the lien relotes to the follow- 2~i~~
iog taxes.
NAME OF TAXPAYER •
D. E1~q~! ~ Mt~j H. ~ei~~t
RESIDENCE "
1n 1 H~at l~it
, !b~ ti~t~ llo~r3ia
UNPAiD BALANCE
KIND OF TAX TAX PER(OD ENDED ASSESSMENT DATE lDENTIFYING Nk~MBER OF ASSESSMENT
; (a) (b) k) ?dl te)
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PLACE OF FILING
~I~~j~~ ; TOTAI S
. !be't Pi~i~M~ !''~~l+i~ '
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` WITNES$ my hand ot Jacksonville~ Flnrida , on ihis,
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the 23rd doy of ~cYQber , 19
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; SIGNATURE ~t ~Q~ TiTtE
: Jack nt Chief, Special Procedurea Staff
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~ itJOT :~ert~ficate of oifice. autnor:zed by !ow to toke ecknuwledgrneots ~s not e:sent~al fo th~ vahd,ty of Not~ce of Fedcrof Tox L~en G.C.M.
? ~6419, C.B. 1950-51, 125.;
~ PART 3--To be used for retording pu?poses CC