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Form 668 DErA~riENT OF TNE T~EAfU~Y-IMTEIIl1Al ~EVENUE SE~VICE fa qv~~ona/ Uss 8y R~rc+diny Oflios
(REV. 12-7~) CERTIFICATE OP RELEASE OF FEDERAL TAX LIEN . D RECORpE~
• LtIC16 COUfIT1r /L~1. ~
pIS?g1~~~. ~ SERIAL NUMB R , CLERKg~~~CU1t~p~j~~T
AFCORD VERIFIEd 1
'r t ion ~
I hereby certify that as to the fofiowmg-named taxpayer tfie reqw ements o Sect ~
63251a?. internat Revenue Code, have bee~ satisfied with sespect to the taxes enu- 1 ~f ~y
merated below,- together with all ststutory additions provided by Section 6321; and -
that the lien for wch taxes a~d statutory additions has thereby besn relessed. The
prgQeripfti~gr in the office where notir.e6of intemat revenue tax lien was filed o~
ap i z9 , 19~ . is hereby suthaized to make cwtat9on
o~ his books to show the release of said lien, insofar as the lien relates to the follow-
~ i taxes.
NAME OF TAXPAYER
~ ~ ~ro oo. ssc. ~~~4
RES_ IpE ~ E . '
M~Ms ?L
~ " UNPAID BAIANCE
~ KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
{a1 tbl ic! fd) iel
~ y;~1 06-~-T5 i-16-7i6 ~?9-tb~~d? • t.~.~
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; PLACE OF FIUNG Cl~ ~ ~,t ~'O
; j~w C~~ TOTAL S
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WiTNESS my hand at Jacksonvillo, Florida , on this,
~e 27th day of ~Y , t9 B
SIGNATURE TITLE r ~ ~
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AC~C
(NOTE: C~tilicst~ 01 p1 " sutiw?i=W by I~w to tNc~ acknOwNdprtNnts k not ess~ntial to Me vatidity Ot Notiq of FW~rM T~: Lia? G.C.M,
26419. C.B. 1950-1. 125.)
~ PART 3- To be used For recording purposes ' ,
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