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' FC~m 668 DE~AIITMENT OF TNE TNE115Ui1Y-IMTERNAI REVENUE SERYICE FW Optiona( Use By RercWdh~y OffiOt
I (REV. 12-74) CER+~lFlCATE Of RELEASE Of FEDERAL TAX LIEN
DISTRICT SERIAL NUMBER 34os3i
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i 1 hereby certify that as to the foliowing-named taxpayer the requiremenu of Section ~
~ 6325(a), Internal Revenue Code, have been satisfied with respect to the taxes enu- ~ ~~sr
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merated below, together with all statutory additions provided by Section 6321; aod ~<y`c~~.'~
j that the lie~ for such taxes and statutory add'+tions has thereby been released. The r~~~o
! proper officer ~ in the office where notioe of inte~~al revenue tax lisn was filed on ~-~c+bv~
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.n~e 1~ ~ , 19~~, is he~eby authorited to make notation o~s~
1 on his books to show the release of.said lien, insofar as the lien relates to the follow- • p ~
~ i taxes. _ ~
i NAME OF TAXPAYER ~
j
tade i~ard - a a Com n ~F
' RESID NCE
3113 River Dr. ~Q~j 1
' UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDEO DATE OF ASSESSM~NT IDENTIFYING NUMBER OF ASSESSMENT
~ (a) (bl (d (d) lel
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f 941 6-30-74 2-10-75 59-1372806 1,750.79 '
' 941 9-30-74 2-24-75 59-1372806 836.14
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~ PLACE OF FIIING
~ Clerk, Circuit Court TOTAL S
~ St. Lucie County 2,586.43
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- WITNESS my hand at Jackeonville . Florida , on this,
the~rdday of July , 1g 76
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SI ATUR TITLE
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~ ~ Chief S ecisl Prrocedures St~ff
~ N TE: C~?tificat~ of offiur suthori:W by bw to tsk~ acknowlWyrn~nts is not espntuil to tM validity of Nodq of F~zN Ta~c Li~n G.C.M.
~ /9, C.B. 19541, 125.) -
~ PART 3- To be used for recording purposes
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