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Form 668 oEP~Itrt~AErrt of n~E nlEwSUmr-N1E1Wlu tEVEruIE 5fe~nCE Fo. apt~wwl u: By R«wdmg Ol6ce
~r~Y i-~o~ CERT~iCATE Of REIEASE ~ fEDBtAI TAX llEN
DISTRI r• SERIAL NUMBER ST
~UCIE COUNTY FLA• ~}U
273406 B223 P626 ROCER POITRAS
I hereby certify that os to the foliowing-named taxpoyer the requirements of Section CLERK CIRCUIT COURT y'
6325(a1, Intemol Revenue Code, have been satisfred with respect to the taxes enu- RECOIi~ VERIFIEO~
me~ated below, together with all sfotutory additions provided by Section 6321; and " Si
that the lien for such toxes ond statutory addifions hos thereby been released. The
oroper o(ficer in the off'ice where notice of internal revenue tax lien was filed on
Janusrv 28 , 191~, is hereby authorized to make notation
on his books to show the releose of said lien, insofar as the lien relates to the follow-
ing taxes.
`:.1ME OF TAXPAYER v~~~
RESIDENCE ~
~@Z~ ~!¦~l3ir~~r ~i ~
UNPAID BALANCE
j KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~a) ro) (d~ (e~
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: 1040 i2~iI-72 Ob-Oi•~ ti4-+l2~S9i 1.09i.7~4
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? PLACE OF FILING
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C18rk' C,ic+C~'~tt ('•ouR TOTAL ; ~
St L~~c+~ GourKy 1,09i. F4 i
' Fort Pierc~, Flrxid~ (
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WITNESS my hand at Jacksonville, Florida , , on this,
- ~e oth ~r of I~:arch , 19 75 . -
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SIGNATURE IITLE
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c rant i
~ (NOTE• ' cote of o!~'icer outhorized by law to fake acknowledgments is not esscntial to the volidiy of Notice of federal Taz lien G.C.AA.
2641 , C.B. 1950-51, 125.)
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~ PART 3-To be used for recording purposes
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