HomeMy WebLinkAbout0653 ! Form_ 663 DEtART1MENr Of THE TeEwSURY-adiEe+Al IEVBduE SEMCE For Opfiond Uw !r R~oor~dry ORS
(Rtv' iao) ~ «TWUTE OF RELEA~ OF EEDQAL TAX LIEN - .
DISTRICT ~ SERIAL NUMBER ~~r1 I o
264776 b-219 -525
1 hereby certify that as ro the following-rwmed taxpayer the requiremenh of Section _
6325(a), Internal Revenue Code, have been satisfied with respect ro the taxes area- ~f $ 26 ~ tl~
merated below, together with all statutory additions provided by Section 6321; and
that the lien for such foxes and. statutory additions has thereby been released. The ~ P,EC V
proper officer in the office where notice 44f internal revenue tax lien was filed on Y.fIA.
Ac nher 1st , 19 73 , is hereby authorized to make rotation R~T~
' on his books to show the release of said lien, insofar as the lien relates ro-the folbw- IfICUfT~~
ing taxes. 'COftf1~~'ERifiEtl_-
NAME OF TAXPAYER -
RESIDENCE
~ . Z~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSI~AENT DATE IDENTIFYING NUMBER OF ASSESSMENT
la) lbl k) ld1 lel
I 1«i0 21-31-x! Oi-~-~ ~i4-XF~I~i ~.0~
I
PLACE OF FILING ' ~
3tL.UCi• TOTAL =
Fort Rterce, Flocidi~
Jacksonville Florida
WITNESS my hand at , on this,
the 21st day of February 19 8U
- - a~326 p~ 1
SIGNATURE TITLE
Van E. O'Neal t~'%U ~ Chief, Special Procedures Staff
(NOTE: CertiRcote of officer authoraed t»r law to take ackrawledgments is not essential to the volidity of Notice of Federd Tax lien G.C.M.
26419, C.B. 1950-51, 125.) vw
PART 3-To be used for recording perposes