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Form 66B ~ DEPARiNENT OF TME TREA'~1if-WTEfit.Al RfVfNIJE fw Uptiono! U~r By Record+g OrF~ce
~REV CERi~JUTE-Of RELEASE OF iFDERAt TAX UEN 0.~
fliS;CT SERlAL NUMBER ~ ~
20795Z 8191 P25S2 0~E~~
I hereby certify that as to the following-nomed tattpayer the requirements of Section *E VRV 4._-~ .
6325(a~, Internol Revenue Code, have been sofisfied with respeci to the taxes enu-
merated bzlow, together with oll stotutory odditions provided by Section 6321; and
thot the tien For such taxes ar,d statutory additions hos the?eby been releosed. The
; proper officer in Ihe oPfice wfiere notice of inte~nol revenue tax tien was filed on
-A,pSil 20 _ , 19~.1., is he~reby authorized to r~iake nofation
on his books to sFww the retease of said tien, insofor os the lie~ relates to the follow- .
iRg tCxCS_
t~:AME OF TAXPAYElt •
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~ ~ ~
RESIDENCE
Z~0} x. utr str~r~. ~s. rs~a..,. 1~a.
UNPAID B~ALANCE
KlND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDFNrIFYlNG NUMBER OF ASSFSSMENT
~a~ ro~ c~~ cd~ c~~
ioao u.~,.~ ~e~.~e~ ~s.~
.
PLACE OF FILING ~,t
St. C~ TOTAL ; ~5~~
KRO~
~NITNESS my hond at Jacksonville, Florida , on ri,~s,
rh~ 26th ~y of November , 19 73 6~OK 1 PAf,E J~~
SIGNATI~tE TtTIE
~'!-~'~~~~C~"-f •f~s-c
Jack ant Chief, Speclal Procedures Staff
T. Certificote of ofFicer ovthorized by law to toke acknowledgments is not esse~iol to the volid~ty of IVotec~ of Fed~rd Tax lieo G.C_M.
9, C.B. 1 ~SO-S1, 125.)
PART 3-To be us~d fo. recordi cc
n~ P~+rposes
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