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Form 6~8 OEPMiMENT OF Tf# TREASl/RY-NTERNAI REVENl1E SENICE For Oplionof ~Jse By Recading OR'ice
~REV. ~a7>> CERT~iUTE OF RELEASE t1F FEDBtAI TAX UEN I.E~ ItwD +tEC~
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DISTRICT ,~~~~L~ SERIAL NUMBER ROC~ G00 i i
291421 B231 P2594 tERK ta~GJlt OURt
I hereby certify that as to the following-named ta~ayer the requirements of $ection ~ rOPD YEF'FIf~...~.~.~•
6325[a~, Internol Revenue Code, have bee~ sotisfied with respect to the taxes enu- - ~ ~q ~l ~u
merated below, together with all stotutory addiTions provided by Section 6321; ond L rl
tfiat the lien for such taxes ond statutory additions hos thereby been released. The
proper officer in the office whe~e notice of internol revenue tax (ien was fited on ~
Sgpte~tbeT 13 , 19 7~+, is hereby authorized to Make notation _ 3;~'
on his boolcs to show the release of said lien, inwfor os the lie~ relates to the follow- ''"`~r
ing taxes. ~
NAME OF TAXPAYER
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RESID~C~ ~ 3~
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UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
~a) (b) (d) ~e)
' 9~3 12-31,-?3 4?25-?4 59~1~8'96T 1~~'1.40
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~ PLACE OF FILING ~
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~ ~j ~ ~ TUTAL S 1~~.~Q
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a WITNES$ my hond at Jackaonville~ Florida
, on this,
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~ the 31at day of March , ~q 75
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~ SIGNATURE TITLE
~ GGf~:~,(~tiG2,~~-•-~
'J Durant Chief, Special Yrocedurea Staff
(NOTE: Cer ~ e of ofF'icer o~thorized by law to take ocknowledgments is not essentiol to the validity of Notice of Federal Tax Lien-G.C.M.
26419, C. 50-51, 125.) a~~x']Q ~ .
PART 3-To be used for reco~ding pu~poses ~
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