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Form E68 ' , oH/YtiMIfM oF 1HE 1fEAwer.-ME~IK REVk'~rilE SHV1C~ for Oprional 11~ b~d^8 -
(REV. 1-70) ~~T~A~ ~ ~ T~ ~
; a~~~ SEWAI
N~JMgER FIIED 1tND AEC R E
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; 266496 Bk 229 Pg 2774 AOCER ~OI~RAt
i I F?ereby certifp thot os ro the fdlowing~named roxpay~er ~hs requ~rements of Section CLERK CIRCUIT COUAT
' 6325(a). Internal (tevenue Cods, hwe been satisfied with respect to the toxes enu= RfCORD VERIfI~D~~
' muated below, togett~ with all statufory oddifioos provided by Sectioo 6321 s~ ~'n ~~~I •
~ that the lian for wch taxes ond statutory addfions has theroby bee~ released. The JII
proper o~ in the oi~'ice where notics of internal revenue fax lien was filed on
prt.~,t~r 19 , 19_Z~.-is herob~? authorized ro make notation
on his books ro show the release of said iien, insofor as the I'ien reloTes to the follow• 3~~'~?Q
a7
ing taxes.
NAME OF TAXPAYER
~ J. s ~w~ a.s~.cc •3~Gi~
RESIDENCE
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UNPAlD BALANCE
KlND OF UU( TAX PERlOD ENDED ASSESSMENT DATE IDBVTIFlfING NUMBEIt OF ASSESSMENT
(a1 t~l k) ld? (el
10~0 1!•~i-TA ~ !•li-?t ~lt•~O-2~! ~Z~~.
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~ PLACE OF FIUNG
~ ~ C~ TOTAL S
~ 9t. i.ucN County
~ For! Pwr~ce. ~loAd~ `
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~ WIflJE55 my hand at Jacksonville Florida , on 1his, ~
~1e 23rd of January ~ ~ 9 76
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~ SIGNATURE
c rant Chief, S ecial Procedures Staff
~ (NOTE: Certificate of ofRcer cuttwrized by ro toks acknowled~rnents is not es~~id 1o the volidiry? of Notice of Federd Tmc lien G.C.Ati
26419, ~.B. 1950-51, 125.) frn ~ ~sf'
~10 i~~7
PART 3-To b~ us~d for nco~dino pwpos~s
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