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Form 6b8 DEPARTMEM OF iTE T~fIlSU[1f-NTERNAI ~VENUE SERNCE For Oponol Us. ey Record.~g OARce
(REV. 1-70) • ~~T~u~ ~ ~ T~ ~
DISTRICT SERIAL NUMBER 6tf i~CR~CUIT Cp~ ~
1 hereby certify that as to the following-named taxpayer the requiremenh of Section RECQRb YEP,:FtED i~
6325(a), Internal Revenue Code, have been satisfied with respect to the taxes enu- ~j OS pu
merated below, together with all statutory additions provided b~r Section 6321; and L ~A
that the lien fw such taxes and statutory odditions has fhereby been releosed. The
proper ofFicer in the ofFice where ootice of inlemal revenue tax lien was filed on
October 4 , 19.Z2 , is hereby outhorized to make notation
on his books to show tfie release of said lie~, insofar a~s the lien relates to the folbw- ~QnAo~
ing taoca. VV~7 ,
NAME OF UXPAY6t
3aa~s L S~i.th
9odths Se~rniu C+~n~r
RESIDENCE
; 8o~rt~ No. 4~ ~t 610
~o~rt Plerce Florid~ 33~50
~ uNPa~ enuwcE
~ KIND OF UX TAX PERIOD END~ ASSESSMENT DATE IDENTIFlftNG NUMBER OF ASSESSAAENT
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: 94I ~it~holdir~g G9-3U-71 C9~-12-?2 59-1213752 S 89~.1i8
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;-i PLACE OF FILING
C1B~CS CiTC{11t CWii't TOTAL S ~q~,~
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WITNESS my hand ot Jacksonville Florida , on this,
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the~SSlLdoy of__1~jri1 , 19 74
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SIGNATSIR~ T1T.E
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~~`3 ' : Cerfifitaie of officer outhorizcd by law to take acknowleclgrnenh is not esienho! fo the validity of N~hce of Federo~ Toz lie~, v.C.M.
2ls 19, C.B. 1950-51, 125.) kS
PART 3-To be used for recording purposes
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