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Form 668 oEMRrINEPrt oF n~E nIEwSURr-NrEINAt REVENUE S~VICE For Oprionol U~e tr R~oordnp OR',ce
~~v -~.~o~ . CQT~iCATE OF ~AfE Of ~fDQAI TAX t~N
r
DISTRICT SERIAL NUM66t
~~;~~j~
88674 Bk 230 Pg 1602 ~~
~ he~~br extif~r that os -o ths fdlowi~g-namsd roxpoper the requiremerds of Section
6325(0), Internol itevenue Code, have been wtisfied vrith respect to the taxes anu-
merated below, together with all statutory additions provided by Section 6321; and
that th
li
f
h
d ~~' 8 ~"~ 09
e
e~
or suc
taxes an
statutory odditions hos thereby been released. The
P~gui~--6in the office whe~e noticy~f inbrnal revenua tax lien wos filed on f~ ~ ~
, 19 , it heroby outhorized to make notation S~
~~c
p
~
on his books to show the release of soid lien, insofar as tho lien relates to the follow-
t
~ ~
~
R ~
T g~,
axes•
~9 CLERK C~CIlIT COUR
w1ME OF UXPAY6t ~ECrRn ~•r r:~r:E t-
~ i 1lulir 1i 7be~t
~'~2~
r~~uEt~ce
~ aas;aa ~i. ~pt 1t -
3i~4
qND OF TN(
TAX PERIOD ENDED
ASSESSMENT DATE
IDB~TIFYING NUAABER UNPAID BAUWCE
OF ASSESSMENT
(al Ibl k) td) (e)
9~ID I~~~9 t~'l~2~~ _ ~••1~2 183.~i
9~1 0~•3L•74~ Qi~,~4 ~•1+~9~?22 4~i.?!
, r a.n~.c vr n~U`N ~~~ ~
I
~ ~~~
TOTAL ~ ;,~,,~
WITNESS my hand ot Jacksonville~ Florida
, on tha,
~ 13th ~ af FebruaTy ~9 81
i V/
Van E. 0'Nea ~ . Chief, Special Procedurea Staff
(NOTE: ~erti6cate of oNRcer wtFarized by law ro ok~ ackrwwledemenK is no~ eue~id to the voGd~r of Naice of F~clerd Tmc lisn G.C.M
26419, C8. 1950-51, 125.)
~ ~ PAltT 3-To b~ vs~d fo- ncordi~p Purpos*s $D~~ P~~
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