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Forth CCO Deptartment of the Treasury - Internal R•vnu• Service 4~7~718 ~ /
(a~,.t3•ptemb•r,97a) - Certificate of Release of Federal Tax Lien
District Serial Number - Fo. opt(onat w. by Ra~cordlnp otnc•
443122 B-308 F-40R i~T9 OCT 26 ~1 ~ f 3
l t~rtify that es to the fdlowing-named teucpayer. the requirements of section 6325(a) FIt.ED /~Hl~ k± (;uK~tU
of the Internal Revenue Code have been satisfied for the taxes listed below and s ROGER
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for all statutory additions. Therefore. the lien provided by Code section 6321 for CIEP.K CIRCUIT COIAtTj
these taxes and additions has been releast~d. The proper officer in the office a[cc':oti~cr~r9EI' ____.°~~y,1.._._
where the notice of internal revenue tax lien was filed on I•:ay 3 ,
19 79 . is authorized to note the books to show the release of this lien fa
these taxes and additions. 4va~,718
Name of Taxpayer ~ ~
Residence ~ ~
h't Pl~04 ~1~0!'j~
f Unpaid Balance
Kind of Tax Tax Period Ended -Date of Assessment Identirying Number of Assessment
~I ~ (a) (b) [c) (d) (s)
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1
1 i
I Place of Filing
Iayi+~ ~ Total S ~~bs~
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I This certificate was prepared and signed at a c ks onv i 11 e , P 1 o r i d a , on this,
the 15th day of Oc ,19 79
Signature ~ Title
' Van E. ~~v Chief, Special Broced•~res Staff
E (Not•: Cerfiticste of otlicer authonred by law to take sc~nowledpmems %s not essential to the validity o/ Notice o/
Federal 7a: Lien (3.C.IIr. 2b1/9, 19541, C.B. 125.) (S~ V~g ~ t W
aa~(J( p~ Form 668 (Rev X78)
Part 3 To be used for recording purposes i