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~ fOfm 668 OFPARTI~AENT OF THE TREASUR1i-NTERMAI REYENUE SENKE For Opfiono~ the er Record+g OIFce
~REV. ~a~i~ CERT~IG~E OF R~tEASE~OF FEDBtAI TAX iIEN .
DlSTRICT .IA~1~9~1VlLLE SERIAL NUMBER ' ~ r~:, ~'i.JiB~i
304835 Bk 237 pg 3981 L~n' W
~D~i+i P~i'{i115-
; I hereby certify that as to the following-namad taxpayer the ~equirements of Seclion Ci£4ttC .G:'3~M~~~ ~
6325(a), Interna) Revenue Code, have been sotisfied with respect to the toxes enu- rr±s~ y~t'~~~~.. ~
merated below, together with oll statutory additions provided by Section 6321; ond ~~~u y~ ~
that the lien for such toxes ond sfotutory additions hos thereby been releosed. The
prope~t~
c~ ~the office where notita~gf internel revenue tax lien was filed on W
, 19 , is hereby authorized to r~tiake notation ~/~p~~
on his books to show the releose of wid lien, insof~ os the lien relates to the folbw- ~~VD
irig taxes.
NAM OF T~E'~i~1 ~~IE P~ P~i~t* R~G
REStD~~ ~2, ~
~ ~p~'O!~ A. ~2
UNPAID BALANCE
KIND OF TAX TAX PERlOD ENDED DATE OF ASSESSMENT IDENTlFYING NUMBER OF ASSESSMENT
~a) ~b~ ~d) ~ ~eI
943 09~30~T~ 12-23~T4 S9~-IOP?18~ 7~?96~. ~3
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a PLACE OF FIUNG ~ ~ ~ •
S7. L~E ~Q4~TY TOTAL S T~'~44.~
' FORT P~.s [~AR~11
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~ WITNESS my hand or Jacksonville, Florida
- , on this,
the i 5th day of ~8y 19 75
w; ,
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~ SIGNATURE ~ TITLE
4
a r J ck Durant Cheif, Special Procedures Staff
~ (NOTE: Cer ~cate officer outhorized by law to take ocknowledgments is not essential.to of No6ce of Federol Tuz lien G.C.M.
~ 26419, C.B. -Sl, 125.)
` PART 3-To be used for recording purposes hd~
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