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Form 668
f oE-J11tt!NEPrt Of n1E nEwwtv~liFi~lAl eEVEtiUE SelvKE For Opiond Ufr 6r Rero.dny 01Rce
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~eEV. CBtTWCATE Of RELEASE Of F~DQAI TAl(11EM
DISTRKT ~~wu~ s~~uu Nuw~aER ~
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292856 B7c. 232 P~1690 S?,~U9~6
I hereby ce~tify that os ro the following-oamed taxpoyer the requirements of Section
6325(a~, Internal Revenue Code, have Iseen svtisfied wifh respett to the taxes enu-
meroted bebw, together with all statutory add'itions provided Section 6321; and
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~~~ ° Octo~er ~~e where notice~~f intemd revenue tax lien was filed on
, 19 , is hereby outhorized to r~iake nototion fu~~ ~ pp~~
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on his books to show the releuse of soid lien, iruofar as the lien relates to the follow- Q~~
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R~AS
i~g taxes. CtERK C~tCUtT
OF
nLaN~~~ RECf•Rif 17FIF;[p~ C~~"y,-
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KIND OF TAX
TAX PERIOD ENDED
DATE OF ASSESSMENT
IDENTIFYING NUMBER UNPAID BALANCE
OF ASSESSMENT
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PLACE OF FILING ~~ ~ ~~
". F~tT PfERCE. R~ORlQA TOTAL S 1~T:~sTB
wITNESS my hond ot Jackaonville. Florida , on th~s,
~,e 13th ~y oF February , 19 81
C S1GtJATURE ~ T1TLE --
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Van E. 0'Ne ~ . Chief S ecial Procedurea Staff
(NOTf: Certificote of ofFicer authorized by law to ake ackrawledgments is nd asentiol to the validity of Ndice of Fedard Toz lien G.C.M.h jm
26~19, C.B. 1950-51, 125.)
~ PART 3-To be used for recording purposss 81~~ p~~
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