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Form 6~ D~pMtra~rN of bM Troaury - IntNml Rravlau~ SMViC~
tRev.Bpt.a~b.r,o78, Certificate of Release of FBderai Tax lien
District S6riai Number ~ Fo. optland u.. a Aoca•!rg oMlo~
_ ~ 441050 Bk 307 Pg 159
- X80 SEP 22 P!~ 12~ 09
I cefiiy that as to the fdlowing-named t~ucpay~er. tha requirements of section 8328(a)
i of the Internal Revenue Code have been satisfied for the taxes listed below and { Q A ~ECOftDEO
for all statutory addfions. Therefore: the lien provided by Code section 8321 for TRAF~A•
I these taxes and additions has _been released. Tt~e proper otf'~cer M the office titi~UlT COUR~
where the notice of internal revenue tax lier?<was filed on April 17 ~~p ~R~tEO_~
t9 -79 . is authorized to note the books to show the release of this lien for
these taxes end additions. ~M~~
Name of Taxpatrer
Resi~~e~ ate. ~ ,
M~ ~
_ - unpaid Balance
~i Kind of Tax Tax Period Ended Dste of Assessment IdentNying Number of Assessment
[a) (bl [e) (d) "
~ j
I ! ~ ~li~ 1~•Oi•~t Ooh-~7~i 1s~~
If
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i
Place of Filing
- ~ Lit+Bti~ 0~¦nll~ ~Ila~lriw Total i 3~,i~'P!
~ l~~iery ~a'!~a ~
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t This certificate was prepared and signed at Jacksbrrville. Florida , on this,
the 16th ~y~ Set er ~~g 80
Signature ~j Title
Van B. 0'N G~ J'am' Chi f
e S c
(Not~c C•rt;NG•tta of oH;c•r •ufno.&.d by ar ro ake acknowrdym.nes a not d.sen ;N fo rota vali0tryr o/ Norlcd o1
Federal Tau CJSn d.C.M. 26NY, fY541, C.B. 126.) 8~~ ~ ~ taID ,
Part 3 - To be used for recording purposes Form 668 (Rev. s-78)
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