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- Form 668 DEVitRTMENT Of iHE iREASIIaY-M1TEtf`ULL tEV6Nt~ SfNlLE For Op,onol Ux By Recn.diny ORice
~~v. i-~ol CFItTi1UTE OF RElE~ OF fE08tAl TAX t~N
DISTkICT J~O~~t SERUIL NUMBER . ~
208887 s192 P912 ~E~ ~ a ~ -
1 hereb certi that os to the follow; ~~ERl.
y fy ng-rtomed taxpayer the requireme~h of Section ~1~
6325(a), Intemal Revenue Code, hove been sotisFied with respect to the taxes enu-
merated be{ow, together with aN statutory odditioni provided by Section 6321; ond
thot the lien for such taxes and statutory oddifions has Ihereby been releosed. The
t~r~ fi'icet in the oH'ice where notice.~q~ ~nternal revenue tax lien was 61ed on ~
~ , 19 ' a, is hereby authorized to r~loke notation ~)c
on his books to show the release of soid (ien, insofar as the lien relates to the follow- /GrV93
ing taxes.
NAME OF T/1XPAYER ~
oiili~. 0. 1t~s+rt -
RESIDENCE
~ia -
Ts. ~s~r, Fl !~l~~
UNPAID BAL4NCE
KIND OF TAX TAX PERIOD ENDED ASSESSAAENT DATE IDFNTIFYING NUMBER OF ASSESSMENT
lal Ib) kl td! l~l
1QM t~l1•i~ 3•2i•N ~7•~M3~ti 1ls.Ati
PLACE OF FILING
~ ~~7It ~
~ ~ TOTAL S 7fSs~
1T_ 1'i~_ TZdlY
WITNESS my hond at Jacksanville, Flortda , on this,
s~ox~ ~
the 26th day of ~ve9ber, 19 73
S~GNAT RE TITLE ~
~,t~l// .,Ctz ~ -st
Jac ant Chief, Specisl Procedurea SCaff
E: CertiFicote of officer outhorized by {ow to toke ocknawle.igmen!s is not essent~ol to ~he valid+ty of Nofice of federol Tax L~en G.C_M.
261i9, C.B. 195Q-51, 125.)
PART 3-Yo be used for recording purposes CC