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Furm 66Ei [>fPARIt.~ENT Of THf TRExSURY-WTt. r;~1 2EVfNUf SE1tVKE ad~nq Ofi'ice
~Q~v. CERflRUTE ~ RElEASE OF FEDERAL TAX LIEN ST. ~uC~E cau • ~
i;l~i RICT. ' SERtAI NUMBER ROGEn ?C{1ilAS ~
CLERK Ctfi~U1T COURT ~
JaotN~ti1L~ ~'1~ 08 4 O.R 1 401 RF.C^F.U iiEti'F1fOr--- ~
I i~ereby cert~fy thot as io the fo!lowing-named taxpoyer the requirements ot Se.:tion ~S p~ - Q~,
6325(a!, Inter~ial Rsv~nue Code, have been sa6sfied with respec! to ihe taxes e~v- ~~e Z5 ~ 1~1~
merated below, togett~zr wiih o!1 stotvtary odditions provided by Section 6321; and A~
that thes lien for suc}i toxes and stotutory additions has thereby been released. The
proper oflicer in tne office where notice of interoal revenue tax lien wos filed on
__~ay 3 19~1, is hereby autnoriz~d to n'ioke notation
on his books lo st:ow the releose of said tien, insofar as the lien relates to the follow-
ing ~oxeS.
NAME OF TAi(PAYER
d~ ~ LeriM C~r~~
RESIDENCE
ati~r~e ~
lrort rs,~. !'Lorsda ~
UNPAID BAUNCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTtFY1NG NUMBER OF ASSE55MEM
(a1 t~1 kl (dl (~l
~ 10lt0 I2-31.~69 ~•?A-7~ 26~-2o~•i~,j0 ~TeT.~
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PLACE OF FIUNG C~i;
~ j~~ TOTAL ;
Trar'~ PLro~~ ~latl+ds
WITNESS my hand ot Jacksonville Florida , on th~s,
the ~day of Februarv , 19 74.
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SlGNATURE TITLE
~F"~3
Jack Durant Chief S ecial Procedures Staff
jNOTE: Cert~f~cote of ~c author~zed by law to take acknowiedgmenn is no? essent~al to the vaGdity of Notice of Fedaal Tox lig~~~A.
26419, C.B. 1950- . 125 • G~ P~ 7 7
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Kt ; PART 3-To be used for recordiny purposQS -
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