HomeMy WebLinkAbout1871 r
~ • ~ ~
Fotm 668 oc~n~r oF ~ nF~wer-aarFe~uu e~ve+t~ ~ ~ sor Op~ond 11~. ~ R.cwdMy OIBc.
(R~V. 1-70P CBIT~GTE OF RBEASE OF FEDQAI TAX 1~! o~
' D~~~~ ~ 3 61~9 Bk 238 Page t8'~t i~ tr~EC
' . r~l~~
~ 1 hereby ce~fify that as to the following-named toxpayer the requiremenh of Seciion t~
6325(a), Internal Revenue Code, have been safisfied with respect to the bxes snu- ~r, y.~~?~t~^.~
~ merated below, togelher with al) stotutory additions provided by Section 6321; and ~
~ ifiot the lieo for such taxes ond siatutory addifia~s hos thereby bee~ releosed. The , y 1~~~ f~
; proper ~lin~e ofi'ioe where notice of~'~,ntarnol ra~venue tax lien wos filed on 1S 1 ~
, 19 , a hersby outhorized to make notation .
on his books to show the release of soid lien, insofo~ as the lien relates ro the follow-
ing toxes.
NAME OF UXP~AYOt 3llo~c
>i >~C~ V~ v
RESIDENCE
~i ?~ar.rtdL~ ~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTiFlfING NUMBBt OF NSSESSAAENT
(al (b~ kI (d) (e~
9~1 Oi•-90-~4 3~0•0~•T4 l~•t~0i~i ~,i6S.6~
i
~
;
I
f -
t
R
!
Lt
ft
Qt
h
x
~ -
~
F
&g
Y
~
~ PLACE OF FILING
. TOTAL ;
~ s!i i~ ~!'ti~Q
~ ~ ~
~
~
~ WITNESS my hand at Jgckaonville, FLorida , on this,
~
~
~
' ~e 16th of MaY ~9 75
~ •
~
~
? SIGNATURE TlTLE
~ 3ack Durant
Chief. Special Procedures Stsff
(NOTE: Certificote of off~ av o toks ocknowl eots is nd essentid ro the vcli
26119, C.B. 1950-S1, 125.) °dg`" diy of No~ice of Federd Tox L~en G.CM
~ PART 3-To b~ usad ~ h
~ for nco~din~ Pvrpos~s
~ ~
~ . - ~
. -G- _ _ _ . ~ ~ ~
~ , ~:-~-.h-~ _ ~ y - ~v.h~ < Y.>