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form S6o i ~ ~h?~,kTMENT OF TNE :kF~t.iR~-tNjEh~~! c;'r~`1i1E SEtKtCE fr. Gp+/aral Use Bv Reco-d,ng O`fice
ta~v. : r~; ~ CiRTiRCATE OF RELEASE OF FFDERAI TAX l1EN
' DiS7RtCT SERIAL iVUMBER I St. t~U~CF:i OUH~AS U.
Jadis~wYil3~ ` t 241141 Bk. 207 Pg 2489 CIF~'r, ~t;:CU~i ~OURT /
a F ; ~ : '`n.----
; ! nereby certify tha! as to the fol~owing•named toxpoyer the requirements of Section
6325(a), Internpl Revenue- Ccc1e, have been satisfied with respect to the tQxes enu- f ~
merated below, togeiher w:th alt stalutor~ additior.s provided oy Section 6321; ond F
Ee 2 5 1 2 5 s P H T
, that the lien for such tozes and st4h~tory additions hos theraby tseen releosvd. The ~"1 1~ ~
r er ofi' er i the ofiice :vhere notic f internn) reve~ua tax lien was filed on i~~
~ ~ ~ovem~er ~ _ _ , ~9~~_, is hereby authoriied to make nototion
on his books to show the re!sase of said lien, insofar os the ?ien retotes to the fallaw-
ing taxes,
NAME Of TAXPAYER
' ~ t ~rtl~
Ts~ti D~t! ~Lo~
i R~;IDENCE
; lt 3 ~oc SZI C
~ ~~ct ~Lares, i?L~tiia 33~70
~ UNPAiD BALANCE
~ KIND OF TAX TAX PERtOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSES$MENT
~ lal (b? k) ld) lel
i Si3 1?rJI.79 07~e3•72 3~!-lli4~t~ 2,273.1~
~ 913 12~•=1,•71 06•2~•72 ~-12~4~ib t,864, ~9
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PLACE OF FIUNG
Cl~s1[. Clsw~it Ceult TOTAL S 4~ 137. i~
it Lrets Co~q .
~t ttw~e~w _ 11~lrb
WITNES$ my hand ot _ ~acksonville, Florida , on th~s,
~}1e 2Qth day of Februa ry , ~ q 74
SIGNATURE TiTIE -
,;ack c`~rartt ;
iNOTE: Ce~t~ficote off er ouThonzed by luw to toke acknowtedgmenTs ~s not essenhal to the vaGd~ty of Notite of federal Tox t~en G.C.M.
• 26~19, C.B. 195 51, 1 5.~
` PART 3-To be used for recordin T C~~~ ~A~E
i g purposes Ct'_ ,
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