HomeMy WebLinkAbout0587 - -
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form 668 DFaAR7MENi OF 1HE TRE~WIRY-~.iTERNAI ~vEWI~E SELWCE ~ f; iu: vi++iww, ~i~i oy Fo~.n.+..y
; ~REV. 1-70) ~T~Uh ~ R~~ ~ t~ ~
o~s~~cT s~uu +vun~R
Jyltwl~llL~ ~'l+~eLi~ 2167S4 Bk196 Y 88 ' ~
I hereby certify that as fo the Foilowir~g-named taxpayer fhe requi~emenfs of $ettibn ~
6325(a), Internal Reverwe Code, have been salisfied witfi respect to the toxes enu-
~eroted below, together with aN statutory odditions provi d
e
d by S e ction 6 3 2 1; a ~ d
that the lien for such taxes and statutory additior?s Fws thereby bee~ releosed. The
proper officer in the of~'ice where ~notice of internal revenue tax 1':en was fited on
October 7 , 19]1_, is hereby outhorized to nioke notation
on his books to show the release of sa~d lien, iosafar as tfie lien retates to the folf~w-
ing taxes.
, NAME OF TAXPAYER Y~y~ j, ~TjB
RESI~ENCE ~ jj~~~
lrara ts~atN~ f3~a~l+i~-~31~5~
JNPAID BALANCE
' (a) tb) (c) ld, (e)
KIND OF TAX TAX PERIOD ENDED ASSESSMETIT DATE IDENTIFYING NtJAABER OF ASSESSMENT
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; y~ 1~+33~7 }~6-T3
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~ F~~EO ay~ +~ECUROFO _
~ S1.lUCIE CJUNTY ft~.
ROCEN P)~TRAS v
~ CLERK C;~GJtT CQJ~7 4
ECGRD '+iE-. ~ !EU
6 4 0o PN'75
2985'78
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~ PUCE OF FIUNG ~s l~ois C~~
~ s~ j~~ TOTAL S
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Kr
v:i
, on this,
Jacksonville Florida
~ WITNESS my hand at
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31st ~ of December, 19 74
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~ SIGNATIAtE • TITIE
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J ~ra~ Ctiief S cial Procedures Staff _ _
- Mificote oF offica avthorized by law fo toke acknowledgments a not essentiol 1o the vnlid~r of Natice of fed~rd Tox lisn G.Cl~A.
~ 6I19. B 19 125.) .
~O~K ~r'tiV PART 3-To be used for roscsdin~ purpos~s 88
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