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Fom~ 668 O~ENT Of tME 11IEAStJI'r-NtEwAI ~ SHWCE For Opriawl Ur ~r R~oordnp 016a
(REY. 1-70) ~~1uh ~ ~ ~D~~ T~ ~ ~~~1 ~~~;Gpp
DISTRlCt SERIAI NUMBER ~ - t6 ~i~~
z94o~z B233 P433 ~p po~~a~o ~f
R~t ;;~ccu r
1 hereby certi that as to ths folbwins-namad taxpayer fhe roquirements of Section REed~n Y~p+Flp~
6325(0), Internol Revenue Code, have beea sotisfied with respect to the tmces enu-
merated bebw. ?c9etiier with aN statutory odd'itions provided by Section 6321; ond ~~5 ~~~s
thot ths 1'~en for such taxes ond stctutory addiiioas has thereby been releosed. The
prQpero ff~ ' ths office whera no~
Qf mienwl revenue tax lien was filed on
c~z ~ , T9 7'+ , a hereby autlwrized to moke r~orotion
on his books ro show lF~e rdeose of wid lien, inwfar os the lien relctes b the folbw-
ing tmtes.
NAMF OF TAXPAYER -
R~SIDENCE ~ 1~
M1e~ lMi~ ~M~~i ~li~
tn~a~ s~wvcE
KIND OF TAX TAX PEWOD END~ ASSESSMENT DATE IDENTIFYING NWNB6t OF ASSESSMENT '
~aa ro~ cd~
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CE OF FlUNG ,
(~~e~k~.
~ xt TOTAL ; 1~~~? W
WlTNESS my hond o~ J8eksonville. Florida a~ ~,a,
the 22 day of September ~ ~q 75 ~
~OII 1~f
SI Tt1RE TITLE
a k Durant Chief S cial Procedures Staff
: Certificate of o!i'icer avttwrized by law ro take ocknowladgments is not essen~id ro the volid"~yr of Natioe of Fsderd Tmc tien G.C.M z
- 26419, C.B. 1950-51, 125.) P jy ;
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PART 3-To b~ us~d for ncordin~ purposas `
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