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Form 66H • DEPARThR~NT OF iHE TREASU~Y-NTERNAt REVENUE SEMCE For Opf~orwl Use By Recordng Olfice
(REV. 5~71) CERT~IGSE DF RELEASE OF fEDBtAL TAX UEN F~ ~Me R~
DISTRICT . SERIAL NUMBER 5~ ~~Gc ~ ~w
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304833 8237 P2979 c~fRK c~s:c;~?r i
1 hereby certify that as to the foliowing-named taxpa~ the requirements of $ection RF~~~~ yFF ~;F,~ 4a~fM
6325(0), Internol Revenue Code, have been wtisfied with respect to the toxes enu- ~
merated below, together with al) stotutory additions provided by Section 6321; and ~ j~~q~
thatth~Gen_for wch taxes and statutory addiiions_hat thereby been releused..The _ _ /
prop~r o~'ic~iin the office where notic~~f internol revenue tax lien was filed on
i'~'drea , 19 , is hereby authorized to rrioke ootation
cn his books to show the release of wid lien, insofor as the lien relates to the follow-
ing toxes.
NAME OF TAXPAYER
~~C C0~0~'a~OA Of P'~w P~00 ~,i
RESlDENCE
~7$~ ~
F~t Pi6rClf 3~2
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER JF ASSESSMENT
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~41 12-31•T~4 02-04r~i 59~-i2Q9~i3 6i300.?5
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i `~~T ~ TOTAL ~ ~QQ. ~
± Jackaonville Florida
" WITNESS my hand af + , on this,
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~ the 24th ~Y of Ap~cil , 19 T5
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~ SiGNATURE T1TlE
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~ ac Durant Chief S ecial PYOCedures Staff
~ (NOTE: Cert" ~ te of o~cer authorized by law to toke acknowledgmenh is no1 euentiol to the validity of Notite of Feclerol Tax lie~ G.C.M.
~ - 26419, C.B. 1950-51, 125.)
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~ PART 3-To be used for recording purposes ~j~~ ~
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