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F«m 668 oE+~rr~rrt oF ~ nf~ver-~rewru ~v~+ue s~n+ce Fo. qpr~w~o1 u,. ey R«or~~y o~c.
(~v. ta0) CERTWGTE Of 1~lEASE Of FEDBtAI TAX UEN
DISTRICT • SERIAL NUMBER E p p~
' :T~LUCtE ~~UNTY FIA.
I hereby certify at as to the following-named taxpayer the ~equirements of Section IIOCf ~ PO1TRAi
6325(0), Internal Revenue Cafe, have been safisfied with ~esped to the taxes enu- CL[RK C~~tGillT COURt
merated below, together with all statutory additions provided by Sect+on 6321; and qF~ORR YEFIf1E0.~~
that the lien for such taxes and statutory addi6ons has thereby been released. The f~ ~l pu fZ~
proper of~'icer in the office where notice of internal revenue tax lien was filed on 1 ~
~y~~ ~ , 19_~, is heroby authorized to make notation ~ 1~,~
on his books to show the releose of wid (ien, insofar as the lien relates to the follow- ~
J
Ifl9 fOXBS. . .
NAME OF TAXPAYER
RESlDENCE
~ ~ Ia~r
- UNPAID BALANCE
KIND OF U1X TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
ca~ ~ ro~ <<~ ~d~ ~ cei
iaao t~ra. t~-~.~ o~.v~.r~ a~ a4 ~~o s~o.es
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PLACE OF FILING
~ CLl~'jC~ ~t COiC'L TOTAL ;
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Y, .
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~ wITNESS my hand at Jackaonville, Florida , on this,
~ .
the _318~_day of Mar~_, 19 75
~
~ 5lGNATURE nTLE
ac,~~ '
~n~
DuraAt Chief. Special Procedures Staff
(NOTE: C~fic e of ofFicer autFwrized by law to take acknovvtedgments is not essential to the volid':y of Nofice of federd Tox lien G.C.M
26119 .B. 50-51, i2s.~ p~~s~~ ~ .
PART 3-To b~ used for rQCO?dinp purposes ~,D
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