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Form 668 • t~urr~rt of tte nE~r-RttHe~u~t f~vHOIE sF~E For oplwwt uw er eoordrp a6o.
tREV 1-yob C~iCATE Of RELEASE OF EEDBtAI TAX tl@I
DISaRICT SERIAL NUMBER 374241
'sTMlarl~d3L~ Bk 272 P 299 -
I hereby certify that as ro the fdbwing-riomsd taxpayer the requirements of Section
6325(0), Internal Revenue Code, have been tat<sf'ied with respect ro the taxes enw
merated below, together with all statutory additions provided by Section 6321; and ~ ~P 30 ~ ~ 34
that the lien for such taxes and sron,tory addifions has thereby been released. The
proper ofF~er in the office where notice mtarnol revenue tax lien was filed on ~ y~T
l ~E TY~f A.
August yy , 19 7~ , is herebtr authorized to make notation k
on his books ro show the reiease of said .lien, insofar as the lien relates ro the fdbw- ig.Ef1K tXIURT Q
ing taxes. RECOkO YERtitEO__.__~_.._
OF TAXPAYER - -
~
REST NCE btltfl~ - -
~ t~~~ ~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIF1fING NUMBER OF ASSESSMENT
~I la) lbl (c) ldl let
LIB 1~-~-?~ 41-~0-7T ~~-74~ 1~'~1r~
i
1~ ~ ~T~
PIACE OF FILING - '
~ TOTAL s~•,~
Foot Pi~ro~. Flafti~
WITNESS my hood at Jacksonville, Florida _ , on this,
~ 18th of September ~ 1 q 80
SIGNATURE TITLE
Van E. O'Neal ~ Chief S ecial Proc d r S aff
(NOTE: Certificate of ol6cer authorized by law to take ockno~wledgments is not essentid b the vdidihr of Notice of F.derd Tox lien G.C.M.
26419, C.B. 1950-S1, 125.) ~ '
PART 3-To bo usod for rrcor~dirq psrrposos i
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