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Forn- 668 o~tn~r+r oF n~ n~wwett-art[~t eEV~ue s~e~tE Fo- qa~~aal W. sy R.oo.dny ORkv
~~v t-ib~ ~ - C~T~ICATE Of R~FASE OF EED~AI TAX tIEN ~
DISTRICT _ ~~~~ SERIAL NUMBHt ~~~
1 hereby cefify ~hat as ro rhe fotbw~n$-rw m~r~ ~~~ K~ ~
6325(a~. Internal Rsvenue Code, have been sa6sf'ied with respect to the toxes e~u-
:
19~ MIIR 19 AM 11 09
meroted below, togefher with all statutory odditions provided by Secfion 6321; cnd
that the lien for such taxes and statvtory additio~ hos thereby bee~i released. The
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p
icer in the of~
p~oper oH
ice where notice of i~lenwl revenue tax lien wos 61ed on T:i A.
R~~ ~TR ~
~ . 19 , is hereby authorized ro make norotion CLEAK CIRCUIT CC
on is books to show fhe release of said lien, insofar as the lien relates to the follow- ~
ing laxes. REr.t~[l Y~ r-~r'r!~ .
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RESIDENCE
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~Oet IKs. 33~0
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KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDHYTIFYING NUMBER OF ASSESSMENT
lal l~l i~l (dl (el
9~t 22~31+-TS O4-t1Q'?d 59~-i~31ib09 I?*?iS.12
~ncE oF F~ur~ ~~ CLi+wdt tb~si
8ri. LI~~ ~ T4TAl ; ~'~~12
P~. ~i~j l~i+ 3~~Q
Jacksonville, FL.
WIINESS my hond at , on this,
the 19 ~r af Feb. ~9 81
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VAN E. 0'NEAI. ~~~
(NOTE: Ce~ficofe of oH'icer a
26419, C.B. 1950-S1, 125.)
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iii~C .
CHIEF SPECIAL PROCEDURES STAFF tt
by law ro taTc~ acknowledgmenK a not euential fo the volidity of Notice of federd Tmc lien G.C.M.
PART 3-To b~ us~d for ncoe~d~q P~To~ ~~~ ~~ ~
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