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Fwm 66B DEPARIMENT OF ttif TRfASURY-KfERItAI tEYENUE SERVKE . Fo? Optionof Ufe By Re~crdng O!I'ice
(REV. .1.70) ~ R~(,~~ Q~ ~~~1 T~~ ~ ~ .
DISTRICT SERIAL NUMBER ~ .
J 2i~?97 ~ ~a ~
1 hereby certify that as to the fotlowing-named toxpoyer the requirements of Section ~ Qt ~
6325(0), Internol Revenue Code, hove been wtisfied with resped b the taxes en~- ' ' .
meroted below, together with all statutory odditions provided by Sectio~ 6321; and '
thnt the lien for such taxes ond statutory additions hos thereby been released. The
pr . officer i~~ oif'ice wF?ere notice~ internd re~renue tax lie~ was filed on
, 19 , a hereby outhorized M niake nototion 2~33
on his books to show the release of soid lien, insofar as the lien rela?a to the folbw-
ing tcxes:
NAME OF TAXPAYHt '
m~~ o~ a~ r~r~s m.
~tar a.~t. 1 e~.oc s9
l1~elAi?
UNPAtD BILLANCE
KINO OF TAX UX PERIOD ENOED ASSESSNIEM DATE IDENTIFYING NUMBER OF ASSESSNIENT
~a~ ro~ kj cd~ t~~
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1~Qy0 L3-~7~0 Iy-~S-7R. ~-ai-~l3~0 3Sb•9!
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PUCE OF RUNG
F CL~~ TOTAL j Z,~~~ -
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~ , Jacksoaviil~, Fiorida
~'ITNESS my hond ot , on this,
~ ,~e 16th doy oE Iiova~ber , t 9 73. 8~?~~!( ~
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S!GNATURE - 'r1TlE
, ~~C'-t~~ !Q I ~
Jac aat Chief, Special Procedurta Staff
~ (Nb : ~Fcote Gf O~IiC~`? pufh,r~zed by icw t~ teRC ackr.o.~ledgmenis is no~ esseRf~at ro the voi~d~ry oF Notice af Federol Tax lien G.C.M.
1G4i4, C.B. i950-St, 125.) •
PART 3--To be used for recordi~g purposes CC -