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Foqn 668 DEFNtTMfNT OF TIE T!E/~SUlY-tJTERNAI tEVENUE SElVICE Fo. OPr~onol U,e Br Reco.dn9 Ol~ce
~REV. ~ a» ~ ~ CERT~ICATE Of REIEASE OF FEDNtAt TAX UEN
~~n~C~ J SE 289~28 Bk Page 2tt Z ~~?~~E C9
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1 hereby ceriify thoT os to the following-named ta~oyer the requiremenh of Section Rfr~v Rx Ci~tCU1T.~p~
6325(0~, Inter~al Revenue.Code, have been sotisfied with respett fo the faxes enu- ~ YfR~FlfO=„~~
merated below, together with oll sfotutory additions provided by Section 6321; and
~ thof the lien for such taxes ond stotutory additions has thereby bee~ released. The - Pj~ ~
proper ~fFic t~ office where notice~$f interno) revenue tax fien wos filed on
g , 19 , is hereby authorized to rtiake notation ~
on his books to show the release of said lien, insofa~ as the lie~ relates to fhe follow- 3~~/~
ing taxes. Y
~i~~~ 14~t i Doauit P ~
RESI~E~ ~
Pl~~
UNPAID BALANCE
KlND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(a) ro) ~d) ~e)
9~1 ~~-04 ~'l~ ~*1~2~8 ~ ~i1'8.l~
; 9~ T3~12 0~6~-24•74 ~1~7~88 i'~'1~i.86
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~ ~f~t T+V03" 06-2~Iw74 5S-~~ 2~4~3.71
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~ PLACE OF FILING
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~T PjERCE. Ft
O~QA , TUTAL S 2!$98.24
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~ WITNESS my hand at Jacksonville. Florida
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d , on this,
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? t~e 1 th day of t"~v 19 75
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~ SlGNATURE T1TlE
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~ Jack Duran ; Chief, Spacial Procedura Staff
~ (NOTE: Certi6cote f o er outhorized by law to toke ucknowledgments is not essentiol to the valid~ty of Nofice of Federol Tax G.C.M.
~ 26119. C.B. 1950- 1 5.) ~ e ~ .
~ PART 3-To be used for recording purpos~~
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