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Form 668 ~ OEMRT?~AENT OF tt1E TtEwStlett-ar7EMAt eEVENUE SHIVKE ' For Opriond l/x ~ Recnrd~ng 016ae
~REV. ~a») tERTi1GTE OF RHEASE Of FEDBtAI TAX tld~l fIlEO RHD ~EC RE
p~STRICT SERIAL NUMBER iT. IUC~E COUN~Y ~l~
s~i:'~~-`*'~~~~-~ 286698 8229 P1821 CLE
k Cfi;Cd~T COUItT
I he~eby certify that os to the following-r.flmed toxpayer the requirements of Sedion CORO VE~~;I~D
6325(a). Internal Revenuc Code, hove been siatisfied with respect to the toxes eiw-
meroted below, together with oll statutory ~dd'ilions provided b~r Secfion 6321; and - ~ 9~~~~{~
that the lien for such ~axes and sranr~ory addirions has rhereby been released. The
proper o~'ic~ ir~~e of6ce where notiaj$f internol revenue tax lien was filed on
u Y , 19 , is hereby auM~orized to Make notatwn ~7~•i ~
on his books to show the release of soid lien, insofar as the lien relates to the follow- ~F` 4~ i7~~
ing taxa.
NAME OF TAXPAYER ~
ts~~
RESIDEN~E ~ ~
M~~ ~i 3~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED DATE C~ ASSESSMENT IDENTIFlfING NUMBER OF ASSESSMENT
(al (bl kI Id1 le)
x~ 3-3~-7~ 6-2~7~? 9l~~7~ ~1Q~1•14
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P~ACE OF FILING . . , f„ _
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' t, i: i _
~:.~,~.`.:::'tc f :~L-,;iY . - TOTAL ; ~r•~
. . . : s ~t:. : i
w~TNESS my hand at Jackeonville, Florida , on this,
the 19th ~y of July , ~ 9 74
SIGNATUR ~,~~r~^ ~y~ TITLE
Jack Chief, Special Procedures Staff
_ ert~ficde of afficer outhorized by Icw to take acknowledgments is not asentiol 1a the volidi!p of Nofice of Federd Tax Leen G.C.M
26I19, C.B. 1950-51, i25.) Q~ ~Q
PART 3-To be used for recordi~ purposes d~K~rf.rV PA~~rV~
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