HomeMy WebLinkAbout1692 , Fo~r, bb8 , U S Tr~£ASURY CE~ARTMENT ir+rEGNat kE~'FhUk SEB'l~ff Js~ D1 q,,., ~ p~i:.. =,`G
CERTIFICATE OF REIEASE OF FfDERAI TAX LIEN
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~ISTRICT ~ERIAL NO. ~(~~A~y~y
v~i~7l r
_JaotsoavilL. ~I+~l~i , 13.~341~_9k 184 . _ P . ~¢16-
I h.reby cere~fy shot os ro the fat!ow~r.;-named toxpoye~ the req.,uements of Sect•on
Yr_
. /~7S1~1 ~,,.EC-3~ oS~E'~E ~:~E ~u.t :scc: i~.:iS~=S.~s ics- Cf ic i=`E i.:.as enu- -
neroted betc.., togethe~ ~+.~th oii stotu~o~y odditions provided by Sechon 6321; and
thor the I~r~~ ~or such toxes ond stntutory odditions hos thereby been relecsed. T~~e lE0 AN3 fiECOR
roper Qfi~c r n the ofF~ce .~here ~o~~ce of internol reven~e tox lien was (;led on lV`'1~ `'OVNn
1L~ ~9~~ ,)q , is heredy outtian:ed to make notot~on R~GE Q~O~TRA~T ~
on his books to show !he rei~ase o( so~d I~e~, ~nsofor os +hr lie~ relo~es to ths ~F~^~ - Y• ''c;~ ~
Following roxes.
NAME OF TAXPAYER Ia Q 341~{17 f~~
JAMFS HIII~HD v
REStDENCE
8lr~ 4~ BQZ lat~ Pl~1'O~~ t10lSda 30~~
ClASS OF TAX ~ UNPAID BA~ANCE
iTox Return Fc~m No_1 PERIOD ENDED ASSESSMENT OATE lDENTIFYING NUMBER OF ASSESS?AENT
{o ) !61 (c } fd ) (e )
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l~bp 12-3L-68 Ir-~-1'0 1~20-Z1r1t70~ 55•83
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P L A C E 0 F F 1 L i N G C~I'~, C~CYitr C01~1'tr
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~ TOTAL 5 55•83
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_ WITNESS my hand at_ Jacksonville, Florida _ , on this,
~
~ rhe 13th . doy of _March - - - j9 75-
SIGNATt~RE - - - -ITLE ---v~+v1?~~~~{~-
_ C' ,~/„(~',~'~CI ~t /
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_ _ _ Jack Durant___ Chief, Special Procedures Staff
= iNOTE~ Cerr~i~.ore o~ o~•~ <:,e~:ie'. ` lo.. r~ r._L. ~_'r~~p..lei ~,~,~rs .s •,nr .ssenr~al ri. I. F
~ - . . ~ ro e ~.v ~ S~ry o{ 'So+~ce o} ede•ol ~ o¦ l•r~ . .M.
- 2h119, C B. 195~} I! IS..i
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PART 3-To be used for recording purposes
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