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Fbnn 668 t~?Ntrt~ttt of ttte newst~e+r-r~rtfq+~t ttsv~ue s~ Fo? gW:w~d u,. M R.oo?d~ OA~o~
IREV lao) C8tT~1UTE OF RELEASE OE f~AttAX L~1! ~ f~i.ED ANU f~~ ::~~.toEp
DISTRICT SERIAL NUMBER it UtCt r FIA.
RUC£~~ :'''s5
342614 Bk 256 P ?16 CLE~? G°~:~. t ;,~uRT
1 hereby certify that as ro the following-rwmsd taxpayer the requirements of Section RECONt' !Ei':~'r? p{~
b325(a), Internal Revenue Code, hove been so6sfied with rasped ro the tuxes enu- ~ 2 21 1 I7
meroted below, together with all stotutory odditions provided by Section 6321; and
that the lien for such taxes and stoturory additions has thereby been releosed. The
proper officer in the office where notice of internal revenue tax lien was filed on
August 17 , 19 76 , is hereby authorized ro moke notation Y~~1~
on his books to show the release of said {ien, inaofor as the lien relates ro the follow
ing taxes.
NAME OF TAXPAYER '
J~iL~Y~i
RESIDENCE _
I~ nat~ ~
UNPAID BALANCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMEtVT DATE IDENTIFYING NUMBER OF ASSESSMENT
(al (bl k) Idl (el
k
i
i
s
E
E
~g
i
i
f f'IACE OF FILING
C>~k. Cit•+CUi{ Cowl TOTAL =
~ St. LuCN COtxtty ~o~
Fort PNrce. Flatus
WITNESS my hand at Jacksonville Florida , on this,
the 29th day of~y~L, 19I~_
i
SIGNATURE TiTIE
~y~ ~
S aff
INOTE: Cert~cote of officer authorized by taw to take ockrawledgments is not essenfiol to tFis volidiN of Notice of Fsderd L„r r: r'