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FOnn 6C~8 DEPARTMENT OF iHE iilE1W1RY-~NTERNAI REVENI~ ~V~CE - fw Opliawl U!t Ay Rl~COrdmg OIFicO
taEV. ~ai~~ CERT~KATE OF REIEASE OF EFDBGI TAX UEN
~ DISTaf~ SERIAL NUMBER
288920 B230 P1948
1 hereby cefify that as to the following-namsd ta~ayef the requirements of $edion
6325(aj, Inter~?ol Revenue Code, have been sqtisfied with respect to the taxes enu-
~ merated below, together with all statutory oddtions provided by Section 6321; o~d
that the lien for wch taxes and statutory additions hos thereby been releosed. The
proper o1F'icer in t ofFice where notite of interno) revenue tax lien wos filed on
AuRust ~ , 19 74 ,-is he~eby authorized to niake ratation
on his books to show the releose of soid lien, insofar~ os tbe lien relates to the follovr-
ing toxes. '
: "~~ie~itTi4'y~i~Riea 1~r. I.a. -
RESIDENCE -
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P~ pl~Ol~ l~ 33~i0
uwPa~ a~?uwcE
K1ND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
~ lal (~1 k) idl fe)
' 9~l 0}31~7r4 06~iQ~1i ~9~+12L6i2'r ~913.11
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PLACE OF FILMG •
ST. Ctl~E OOtJt~l7Y
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~ WITNESS my hond at Jacksonville, Florida ~ , on this, ~
~a f
the th day of Februarx„ 19J5
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~ SIGNATURE .
~ ~z=~_~.~t~~2-f~~Lc1 •
~ J k Durant
_ (NOTEt Cer ~ cot officer outhorizrd by law to take ocknowledgments is not essentid to the validity of Nofics o# Federol Tox Lien G.C.M.
~ T6419, C . -51, 125.)
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PART 3-To be ~sed for recording purposes b~ ~
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