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Form E58 DEPARTMENT Of THE TRfA5~1["~.INTERNAL REVENUE SEINKE fw OPrqnol Use Br Reco.d~~g OR;ce
~REV. i ai CERTIf1CATE OF RELEASE OF fEDERAI TAX IIEN
DIST1tICT SERIAL NUMBER ~1~~8 -
293656, Bk 232, Pg 2852
1 hereby ce~tify thot as to the following-named toxpoyer !he requirements of Section
6325~a), Internal Revenue Code, have been sotisfied with respect to the toxes enu-
merated below, together with all statutory odditions provided by $ection 6321; ond f)~p ANO RECOApEO
that the lien for such taxes ond statutory additions has thereby been ~eleosed. The iT. ~({CIE COUNIY FLA.
wwrn Oq~Tq4
proper o icer in the of~ice where notice of interrwl revenue tox lien wos filed on . S
October 17 , 19.7~_, is hereby authorized to ntiake nototion ClEi C~JRT
' on his books to show ihe releose of said lien, insofor as the lien relotes to the follow- QF~'~r:~~ ~~t
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ing taxes. ~ 20 9 34 AM ~ 1 J
NAME OF TAXPAYER
Ii~is'~q~y CQ~pc1~s#.iGri
~~.y
RESIDENCE 3~1~a7~8
P. Q. H~t a~i3
Pt. Pf erce~ FL 33~i2
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
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r:~l C.i6•~3G-74 U^,-~."s~-74 5ff-1424:'_~~ ~sfii>3.~
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$ PLACE OF FIUNG
1 sr. usaE oour~nr
FQR°T PfERC~, ~RIO~A TOTAL $ L~~;3.~
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WITNESS my hcnd ot Jacksonville, Florida , on this,
the 13th doY oF March ~ 9 75
~ OR
= SIGNATURE ~ TITLE
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' Jack Darant Chief S cial Pr d
~ (NOTE- Cerhfcote ~o er o~~horized by law to toke ocknowledgments is not essenhol to the vaLd~ty of Notice of Federal Tox Lien G.C.M.
26419, C.B. 195 -3'f, 125.)
PART 3 To be used for recording purposes
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