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F3.M 668 DEPARTMENT OF THE iIEASl/AY-~ITERNAL RE~ENUE SE~MCE For Optioral Ufe By Retordng OfI'ite
(REV. 1-70~ CERTWUTE 0~ RELEASE OF Ff08tAL TAX UEN " FIlEO AN ^ afCOR
sT.IUCiE ~OUNTY fU.
DiSTRICT SERIAL NUMBER Ro6E~• r01TRAS ~
.T>C=~ILii 266495 O.R.219 2773 CLEFK G~i:it71T COURT
1 he~eby certify that os to the following-named toxpayer the requiremeoh of Section ~E~O~.~, YE~,:~I~c~- ~
6325(a), Internal Revenue Code, hove been sotisfied with respeci to the taxes enu- ~e ~ pu ~ C
merated below, together with all stututory ndditions provided by $ection 6321; and ~~-SS 1~1 ~
thot the (ien for such roxes and statuiory additions has thereby been released. The 2,~~1~
proper ofBcer in the of~'ice wfiere notice c~f interna) revenue tax lien was filed on
October 19 19 73 , is hereby authorized to make notation
on his books fo show the releose of said lie~, insofar as the lien relates to the follow-
ing toxes.
NAME OF TAXPAYER
0~3~atl0 Lp~s.Qr
RE~IDENCE
~ 3~ .
i
i UNPAID BALANCE
; KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
i la1 fbl Icl ld) le1
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~ 11~0 ~.~.3~~! 0~,1?..?~ ~ ~•3!
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; 101~0 18-3y-6+9 4~M~-~T9 " 1.~19.3~
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~ 10~o iz-3~-?+0 ~r-o9~.79 " 1.628.9!
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PLACE OF FILING
" „Q Gleric. C~rC:iFE Cnwt TOTAL S ~~•3Y
= SL Lut~e Couc~ty
- Fort Pserca. Flari~a
t,:
; Y~~ITNESS my hand at Jacksonville Florida , on this,
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the21~._~aY ofFebrLary~, 19 3~
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S!GNATURE TITLE
Jack Du u - ~ Chief S ecial Procedures Staff
(NOTE: Certificote of offic aut ized by low to take acknowledgmenh is not essential to the volidify of N~t~ce of Feder P Tax L'~~~
26419, C_B. 1950-51, 125. ~4 A~E
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PART 3-To be used for recordin~ Purposes ~~~c -
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