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• Department of the Treasury - Internal Revenue Service
Farm
(Rev.$eptember19T8) Certificate of Release of Federal Tax lien
District Serial Number Fo.Opuona) use M Reaordk~p OHk:a
Jaf~~11~ 455513 B-314 P-2510 '.~i9 fi~Y ~ 9 Fs, ~ t, 0
I certify that as to the following-named taxpayer. the requirements of section 6325(a) ftl.f~ ~ at~cei:u, a
of the Internal Revenue Code have been satisfied for the taxes listed below and ft.t~llCtE f.0ux 11f. F t
aTFUs
for aH statutory additions. Therefore, the lien provided by Code section 8321 for ~t.gHCC~~CtstT
these taxes and additions has been released. The proper officer in the office f'~CC,q ~,;R,--.4,__
where the notice of internal revenue tax lien was filed o~ugust 2~
t 9~_, is authorized to note the books to show the release of this lien for
these taxes and additions. 4~~
Name of Taxpayer
i 80115
Residence Z.~ s
Unpaid fl3slance
Kind of Tax Tax Period Ended Date of Assessment Identifying Number of Assessment
la) [6) lc) l~ ls)
i
- - 7aM ~ ~ 1 f
I -
~ ~T
9~1 L3-3~r-?~ 4~-1~-?9 9~~~'~ ~.i9
~
$ ~
Place of Filing alfi'k ~ tr~s ~
9~. f~lloss~ Total = 1~31l1.~3
~eai tSae~y fLoe'l+da ~3~0
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5
This certificate was prepared and signed at Jacksonville, Florida , on this
the ate; day of H^~' er .19 7~
Signature Title
Van F.. 0' ~ ~ Chief, Special Procedures Staff
f,
Mae: Cartiftcafta of oflk:sr autAwlzad by faw fo fakes acknowladpmenta fa not assaMia/ t0 tM valfdNy o1 Nolke of
Fa~daraf Tax LNn O.C.M.2b1fo, 1~SO~1,C.A. 12b.) ,
Part 3 - To he used for recerdi ~ rmsdt~~ Form 668 (Rev. a78)