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fOtm S6E OEPARiMENT Of THE rilEASt11tY-NTERNAI lEVE1JUE SElYICE for Optiawl Us M RsCOrdng Ol6t!
~~v_~.~oy CERTIRGTE OF REtEASE OF FEDBtAI TAX 4Ei~ ~ M a~coaOEo
, iT. LUCIE COUNTY FLA.
DISTRICT SERIAL NUMBER ROCff~ ~;)IT4AS
~~~j~ CIERK CI:iSUIi CQURT
REC~F~~ Vf~'~!FD...~_
I hereby cefify that as to the following-named taxpayer the requiremenh of Section
6325(a), internal Revenue Caie, have been safisfied with respect to the taxes enu- 2 a8 PH ~
merated below, together with oll stafutory odditions provided by Section 6321; and ~
that the lien for such taxes and stotutory odditioos has thereby been released. The ~
proper of~'icer in the oli'ice whe~e notice of inierna) revenue tax lien was filed on
Febr~tTl,,. , 191!_, is hereby authorized to make nototion ~ssL4
on his books to show the releose of soid lien, insofar os fhe lien relates to the follow-
ing taxes.
NAME OF TAXPAYER ~lv,~w J SM1M
RESIDENCE
3b~~ ~ J '
Fbrt PilM• !1 ~SQ
UNPAID BAIANCE
KIND OF TAX TAX PERlOD ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSMENT
(a) (b) (c) (d) ~e)
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~ 1040 12.~7~-n ~5-~-7~ ~I7_~-~S 15~3•3~?
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PIACE OF FILING
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~t~{~ TOTAL ~
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F~xi Pierct, f:o?ide
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~3 WITNESS my hand at iacksonville Florida , on this,
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~1C 1t~'1 (iUY OF March ~ ~9 74
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SIGNATURE _ ~ : T1TLE
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~;r ~ ef S ecial Procedurea Staff
~ (tJOTE: Certific of o cet aothorized by law to take ocknowledgmenh is not euential io the volidity of Notice of Fcderd Taz lien G.C.M.
26419, C.B. 1~- , 125.) g6
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PART 3-To be used for record'in~ purposes r:'
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