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~e~erMarr oF n+e n~~suer-a~ eEVaaue s~ Fo? o,arw~d u,. er R.~~d~y or~ ~
Form 668
~REV. 1-70) - C8tT~1GTE OF RE~EASE OF EEDQAL TAX Ll~1
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3805b5 B-275 P-759 ~~S
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~ 1 hereby cert~f~r Hwt os ro the folbwi~g~wmsd roxpayer the requirements of Section ~~~:~Ftfd
6325(aj, tnMrtwl Revenue ~ode, hove bsen sotisRed with raspect to the taxes enu-
au ~~o~,? ~o~a~ e,? s~~, 6sz~: a~ ~aF 19 1 0+~ f'H'1.
tFat the lien for such taxes and statutory odditions has tl~eby beer~ released,. The
proper ofFicer in the ofPxe where notice'qf mternal revenue tax lien_ was filed on
~ Oc tober 4 , 191.L, i: I~rabp aotFwrized to moke nototion
j on hu books ro show fhe release of said lien, insofar as the (ien relates to the follow- ~;~Z~.
j ~ ing taxes. - ~
` NAME 4F UXPAYER
;
i i~a~t
~ RESIDENCE
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rt ~Z ~i
I UNPAID BALANCE
, KIMD OF UX TAX PERIOQ ENDED ASSESSMENT DATE IDENTIFYfNG NUAABER OF ASSESSMENT
lal rol kI (d1 (el
lAiO L2+-lI-7i ~b-~h?~ ~iii-~4~-1il~ 2,~liS. S~
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3 .
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PUCE OF FlLING
Cieric. G~ra~t GQUI! ~
St 1.1~ ~ ~[1!y TOTAL ; =~~•s7
Fo~t R~uce. Flotid~
WITNESS my hcnd at Jacksonville, Florida
, on this,
~ 22nd ~ of March 1978 ~
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OR
SIGNATI~ ~K~A ~ ~ T1TLE ~
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{~efcion M. L ~fis Acting Chief, Specia2 Procedures Staff
(NOTE: Certificore of ofFice? authorized by law to take acknowfedgmenls is nat esse~tid to ths votidily of Notice of Fede~d Tmc lien G.C.M.
26419, C.B. 1950-S1, 125.) j~~
PART 3-To b~ us~d for neordirp puepos~s
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