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tR.,, ~.,,,~,o~, Certl~icate of Release of, Federal Tax Lien
Dim Serial Number 4;~~ fa opno~w ua. sr R.eaarw o1no.
438434 B-305 P-2098 ~ 30 ~ 1~ 51
1 certify that as to the following-named taxpayer. the requirements of section 8325(a) Std EB E ~ ftA A.
of the Internal Revenue Code have been satisfied for the taxes listed below and t~RK t
for all statutory additions. Therefore. the lien provided by Code section 8321 for
these taxes and additions has been released. The proper officer in the office f1ECePSt VERiFit'fe~..._
where the notice of internal revenue tax lien was filed on 9+-~~+ 2fi
19.x_. is authorized to note the books to show the release of this lien for
these taxes and additions.
Name of Taxpayer
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Residence .
Unpaid Badancs
i~
Kind of Tax Tax Period Ended Date of Assessment Idsntifyirp Number of Assessment
taJ tee t~~ _ coy t.~
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` Place of Filing
~ ~ Me ~ Total =
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Jacksonville, FL
This certificate was prepared and signed at • ~ mis•
the 29th ~ ~ May 80
Signature Title
Van E. O'Neal ~~"~(J Chief, Special Procedures Staff jp
(NotaK Carti/lcat• o/ officN authoritad by Ww to tak• acknowNdpm•nts b not ass•ntld to tM gNONy of Notlc• a1
F•dNal Tax Lien O.C.1L 261fY, 19541, C.6. 12b.)
PtGE i~ Part 3 - To be used for recording purposes Form 668 (Rev. ea8) ~
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