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Form 668 DEPAItrtilENr OP TNE itEwSURY-MEWAI tEVENUE SHVKE For OA-~onol lhe Br Recarding OIFce
~REV. ~a»~ CERT~ICAIE Of REtEASE.Of EED~AI TAX IIEN
DIS3RlCT ~~N~g SERIAL NU/NBER ~~
293~ n k P
I hereby certify thot as to the following-nom4d to~oyer the requi~emenh of Seclior-
6325~a), Internal Revenue Code, hove been satisfied with respect to fhe toxes enu- ~~( 9 ~"3 09
merated below, together with all statutory additions, provided by Seclion 6321; and
thar rh~ lien for such raxes and uan,tory addirions has rhereby been ~eteascd. The
propcr of~'icer i~ the ofFice where notias of iMernal revenue fax lien was filed on Fk o NC F c
SL ~~ f~~,
Acr .~7T~q71~ , 19 , is hereby ouNwrized to Make nototion a~qR ~
on his books to show the releasc of said lien, iruofar as the lien relotes to the follow-
ing taxes. PFCBRt! \'~P.IFI) ^ -
.
~ QF PAYER
M
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RE51 /~sI~E ~ -~~
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~1t. P#as~ ~. 33~2
UNPAID BALANCE
KIND OF TAX TAX PERIOD EN~ED DATE OF ASSESSMENT IDENTIFlfING NUMBER O~ ASSESSMENT
(a) (b) - (c) (d) (e)
9~ 00~-31-T4 0~3-02-7~ ~9-i311609 i9~T13.66
PLACE OF FILING ~• ~ ~
~ p~ p~pR{p~ Totn~ S 9~?I3.b6
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~ jacksonville FL.
WITNESS my hand ot , on this,
the 19~y af Feb . , 19 81
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yl(~NAI'lil'~t 111 Lt
VA~'1 F• p' `~~ . CHIER SPFCIAL PROCFDURES cTAFF tr
(NOTE: Certificote of o1Fic~ ovfhorized by low to toke acknowtedgments is not asentiol to the valid~ty of Notice of federol Tox Lieo G.C.AA.
26119, C.B. 1950-S1, 125.)
PART 3-To bo used for recording purposes ~~~ r~~~