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Fann 668 oEV~xr~rn oF n+E rnEwArett-.MrERruu rtfvE?~n~ 5[RwcE For Opr~onol U~e 9r R«n.d~ng O/Fcs
,eEV. ~a» y tERT~1UTE Of RELEASE OF f~D8G1 TAX tffN
DlSTRKT SERIAL NUMBER ftLE ANO RE'vGR0E0
~y111.E ST.I !E GOUNTY itA.
320466 bk 245 1595 aOc~~ =~+~R~s
1 hereby certify that as to the fotlowing-named taxpayer the requiremenh of Section - CtEpK Ci••~UIT COURi
6325(aj, Inter~l Revenue Code, hove been sotisfied w+th respect to tiw toxes e~u- PfcORL~YERSF=EO !
merated below, together with all stalutory additions provided by Sec6on 6321; and _ tn
thot the lien for such taxes and stotutory oddfions hos thereby been ~eleased. The u~
pro o er in the office where ~otioe mterno! revenue tax lien was filed, on
~O~r 6 , 19 , is hereby authorized to r~iake nototion
on his books to show the release of said lien, i~sofar as the lien relates to the follow-
ing taxes. 3~`+C712,
NAME OF UIXPAYER ~
~t ~s ~t OfiN ~ ~i/
RESIDENCE .
~Z~ =~M 7~
UNPAID BAIANCE
KIND OF TAX 7AX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(al rol k1 (d) le!
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; 10i0 u-31-7~ 11•11•T4 S!~l~i-Z~6i 3,!l6.a4
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~ PIACE OF FIUNG (;~j~ (~~JjT ~(j~'
~ ~ TOTAL S ~~~Si
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~~re,
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~ WITNESS my hand ot Jacksonville, Florida ~
, on this,
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~ rhe 23rd~Y of December, 19 ~S .
~ . ~2 ~
SiGN TURE ~ TITLE
ck U'ur~ Chief, Special Pr~cedurea Staff
~ ~ : Certificote of ol~'icer ovtFwrized by law to toke ocknowledgmenn is not essentiol to the vofidiy of Notice of Federol Tox lien G.CM j
26119, C.B. 1950-51, 125.) jm
PART 3-To be used for recording purposes
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