HomeMy WebLinkAbout2374 _ _ . _ - - - - . _ _ _ - - - - . . ~ _ - - - - - - G -
, .
Form 668 o~~~rt? oF n+E ~w~m-ri?~'"~ eE+erave sfa~cE For ~awl U» 9r Rsaa~ Olic+
~REV. 1-70) ~~~uh ~ ~ t~ ~ ~
, DISTpCT SERIAL NUMBER - ~ IW~rER POI
J , ~ l3~a. REQORO~vL~Iqt~~Ept ~tt
1 hereby certify tha~ as to the following-+wme~ taxpoye~ the requiremenls of Section
6325(a). Internal Revenue Code, have been safisfied with resped ro the taxes enu• ~~i
meroted bebw, together with all statutory odd~tioru provided br Section 6321; and .
thot the lien for wch toxes a~d staturory additions hos thereby been releosed. The
proper oli'icer in the of~ice where notice of intemo(" reve~ue tax lien was fikd a~n .
A.+rt 1 2~ , 19J1--. is hadrY a~thorized to Mcke notatan
; on his books to show the release of soid lie~, insofar as tfie lier? relobs to the foibv~-
ing taxes.
NAME OF UXPAYER ~g ! ~~s ~
` RESIUENCE ~i• js D~ ~ j!~• =i~i~~
~'L~~3
UNPAIO BAL/1NCE
~ qND OF TAX T/?X PERIOD ENDED /1SSESSMENT DATE IDENTlFlfING NUMBEIt OF ASSES.SNIEM
(al ro1 ~ ~ e
f
j ' 10i~0 12-33~6d 10~j0-YO 25?•~~3
~ ~,p 12~33~9 Lo-~3-?0 ~5`!•~t*-'~3
l ~
~
~
PUCE OF FIUNG C3,~~~ C~itr CMtt'~ - .
~ st. L~s1~ Cwt~tt~ TOTi~ S 1~03~~'~6
~ ~t. li~~, ~'3a.
~
WiTNESS my hond ot Jacksonville} ^ri de , on tha,
~~~r of Senramhar, 19
SIGNATURE TITLE
~~t L~tsc
ck Durant C1 Special Procedures Staff
(~,p~; C o~ oKicer outhorized by Iaw ro toke ocknowledgments is nat ase~tid to the vdiditr of Notice of federd Tox lien G.CM
26419oC~. 950-S1, 125.) ~
~ PART 3-To b~ usod for ncordirq pv~pos~s~ P3
BOOi( PAl;f ~ -
- - - - ~ ~ -
w ~K~. , m;~~~
r
~ ~ . `~e::=':1
c~
~
. . . . _ . _ . _ _ . .