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' Fo~m 668 QEPAN7YENT OF 7HF TREASURY-IMTERNAI REVENUE SERVICE For tional Use 8y Reco~d~ng 0/lice
~REV. ~x-~a? i - CERTIFICATE OF RELEASE Of FEOERAITAX LIEN ST.IUCIF c,i~UMTr FIA.
' DISTRICT SERIAL NUMBER ~UCF~ ??it~A$ p,~''
j CLERK C::.;;J~T COURT
; _ J~~~is RfC~~~~. yi%:t;~0
! I hereby certify that as to the following-named taxpayer the requirements of Sect9on
6325~a1, Internal Revenue Code, have been satisfied witi~ respect to the taxes enu- ~ Z3 I 47 PM ~~6
merated below. togethe~ with alt statutory additions provided by Section 6321; and
chat the lien for such taxes and siatutory additions has thereby been released. The
proper officer in the office where notice of inte~~al revenue tax lien was filed on 3~QJ~~(~
M8T1T-; , 19.1~, is hereby authorized fo make notation "
on his books to show the release of said lien, insofar as the Iien ~elates to ihe follow-
in taxes.
NAME OF TAXPAYER
RESIDENCE ~ ~ ~
UNPAlD BALANCE
KIND OF TAX TAX PERIOD ENDEQ DATE OF ASSESSMENT IDENT~FYING NUMBER OF ASSESSMENT
ta1 Ibl lc1 (dl lel
~ ~~~~7
PLACE OF FIL.ING
Q~~ C~T?
~ TOTAI. a 1~,~
WfTNESS my hand at ~ ___,Iacksonvill~, Flori~g , o~ this,
the~Qt.hday of Julv , 19 76
SIG ATURE TITLE
r~n Chief, Special Procedures Staff
N E: Certiticat~ ot oiticer authoritsd by law to tak~ ~tknowlWyrt~ntz is not esstntial to the vslidity of Notid o~ FWlral Tax Liat~ G.C.M.
19. C.B. 1950-1, 125.{ • ~/~~j ~
PART 3- To be used (or recording purposes P~ ~
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