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I FOtm 668 OEMRTMENT Of T1~ TREASURY--fdTEtNAI REVENUE SflVKE For Oplionol Uie Sy Recordi.g O~ce
i iREV. ian)' tNC:~iCATE OF RELEASE Of fEDBUI TAX LIEN
DISTRiCT SERIAL NUMBER aook ~z59 q~, '
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9 0~ RK
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Q1R~ N I Y Q
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; ! heceby certify that as to the following-named taxpoyer the requirements of Sectan R[d I1~ V A: I~D
~ 6325(a}, Internol Revenue Code, have been satisfied with ~espect to the taxes ec?u- ~
~ meroted below, together with oll stahrtory odditions provided by Secfion 6321; ond ~ I~ ~ f~ PM
; ihot the tien for such taxes and stotutory additions has thereby been releQSed. The
i proper officer t~a~i~„~y~ece notice of inlemo{ reveoue tax lien was fited on
! / lU~ (O , ~ q , is hereby authorized to dioke notation
~ on his books to show the ~elease of said lien, insofor os the lien relates to the follow- -
! ing toxes. ' - ~Gn~
; NAME OF TAXPAYER ~'~7VY84
i
~ LA`dRaNCE L- B~TTY I,IT?Y
RESIDEPKE
~ 2027 S. INI)IAN RiV1ui D$.
i FOiiT Pl.~rt~ FL. 33k5z
1 UNPAID BAIANCE
~ KIND OF TAX TAX PERIOD ENDEO DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSE55~AENT
! fo) lb1 kl Id) Ie)
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' 1040 12/31/75 5,31/?6 31U-14-4~45 1,7~3.bb
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j PLACE OF FILING
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~ ST• L~lCIE OOtM~tlY TUTAL 3:t ~ T23 . 6E
~ FORY l~IE11CE. f1A1~A
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WITNESS my hand a~ ~d~t P8~ EoBCh~ Fl. , on this,
the 15 day of Notl. , 19 ?6
do~x PAGf
51 NAT _ TITLE
Gr. .
NOTE: tificde of er wthosi:ed by low to toke ocknowledgments is nd essentid to the volid~ty of Notice of Fedixof Tox lien G.C.M.
6119, . 1950-51, 125.)
PART 3-To be used for recording purposes '