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Form QCp o~O~Km~nt M the Ttwwry • InbnNd FMvMN» 8MVic~
S.oR.,,,b.,,s~e, Cede of Release of Federal Tax Lien
oistrt~t seria~ Number F°` AM ~ 51
Jacksonville, FL :327360 B-248 P-2344
i certify that es tothe fdlowing-named taxpayer. the requirements of.seFtion 8325(a) a~E Ne+~~a
of the Internal Revenue Code have been eatiafred for the taxes listed bebw and 't ~tJl.
for all statutory additions. Therefore. the lion provided by Code section 6821 for
these taxes and additions has been released. The proper officer M the office
where the notice of internal revenue tax lien was filed on Februarg 16
19.]5.-. is authorized to note the books to show the release of this lien for
these taxes and additions.
Nffine of Taxpayer '
Timothy Davis b Eugene Scott PTR
Davis ~ Scott Construction ~
Residence .
2807 Ave. ii
Ft. Pierce FL 33452
Unpaid B
ttUnd of Tax Tax Perbd Ended Date of Assessment Identlfyinp Number of Assessment
W (b) (e) ld)
ii
I
f
941 9/30/74 9/15/75 59-1352618_ 763.65
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Place of Filing _
~ ~ Clerk, Circuit Court 763.65
} St. Lucie County Totsl
Ft. Pierce FL 33452
This certificate was prepared and signed at Jacksonville, FL ~ art this.
the 4th daY ~ Ju ,tg 80
Signature ~ Title
Van E. Chief S ecial Procedures Staff jp
Motax Ca.rtlrcan a ortic« audiwrzad er . ro talcs acknorrtatpaiarus b nat awanHal ro rM vaNdMy a Hare. a
Fadaral Tau Lrafl O.C.M. 26N~ ttlb4f, C.6. 128.j
dfl3f(JJ~ Pt6E rrV Psrt 3 - To be usod for re(~oMM~ purposes Form 668 (Rav. a78)