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~ Form 668 OEMBTMENT OF THE TREI~SUItY-INTERNAI 11fVENUE SERV~CE fOI ~hOnN !he By R iny O/~itl
: caEV. ~2-~4? • CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN Q~,
DISTRICT SERIAI NUMBER a'`i~/ ~
~ 326178 B-248 P-628 `l ~ `
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1 hereby certify that as to the following-named taxpayer the requirements of Section A ~ .
6325(al, Internal Revenue Code, have been satisfied virith respect to the taxes enu~ ' l1~11 ~
merated below.'together with all statutory additions provided by Section 6321; arxt ~O OS ~~,8~
that the lien for such taxes and statutory additiom has the~eby been released. The
~icer~ in the office where, no 9'~Of internal reve~nue tax lien wss filed on
. is hereby authorized to make notation
on his books to show the release of said lie~, insofsr as the lien relates to the follow- t~4d..~p
- ~~~T~~C7 .
i taxes.
NAME OF~TAXPAYER -
~ ~i~lia~ L t Ja~i~ LN~
RESIDENCE s~ ~
; !t r!!l+o~~ ~ls ~i4S3
t UNPAID BAIANCE
KIND OF TAX TAX PERIO~ ENDEO UATE OF ASSESSMENT IUENTIFYING NUMBER OF ASSESSMENT
i lal (b) Icl ldl (el
. 10~0 li~•l1-T! Oi-,1~T6 36Z~1~-l6~ i~t1.10
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~ PLACE OF FIUNG Ci~it r~T~
~ S~ - TOTAI S ~41•10
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h WITNESS my hand ac Jacksonville, Florida , on this,
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~ 30th March 78 a~~ ~ ~
the day of , 19
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~ SIGNATUR TITLE _
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~ O~. Actin Chief S ecial Procedures Staff
~ Van E. 0 Neal R ~ p
~ (NOTE: Ce¦tificab of oHiur authwirW by I~w to tak~ acknowlWqn~a is not essMtiat to M~ valiOity o~ Notip of F~d~rd Ta~ I.i~n G.C.M.
~z 16419, C.B. 1950-1, 125.)
~ PART 3- To be used (or recording purposes
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