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F«m S68 , oo~r,~r oF n+e n~wwer-~e~ ~va~ s~ ror qa~~w~d uw y R.cn.dny o~o. .
(REV 1-70! «T~IGh Of R~ Of fEDBG~ TAX t~i
~ D15TRICT S'tici~i ~iii.~~it ~ •
' 27560 B 2 P a~~~
; 1 hereby certify thot as to the fdlowing-namsd taxpayer ths roquiremenh of Sectioo .
~ 6325(0). Intenwl R~evenus Code, have bsen sa6sfisd with respect to the taxes enu-
merated below, Eogether with all statutory additions provided by Section 6321; a~d ~~ ~~ ~ ~~~ 0.9
thot the lian for such roxes and srotutory additions hos tt~afeby baen roleosed. The
~ope~ oA'icer in the ofi'ice where notics of inkmal revenue tax lien was filed on ~ ~ 0
, Dec ~ 19. ~1974 , 14 , is herebp aufhori=ed to make notation ~ R ~-
on his books ro show the release of said lien, i~ofar as the lien relates io ths folbw- C~ CNtqNT ~T
ing taxes. RfCOHOL'f~ftF~t~ _ ~D~,_.
NAME OF UXPAYER
' ~ .~ lM~~ S?.~~.~
! RESIDENCE ~
. ~ ~~~ .
J~ ~ ~~ ~~ - ~
, IAJPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFlfING NUMBBt OF ASSESSMfNT
: Ial rol kl (dl (a1
~ ~-~••~ 1.fa6r ~ ~9~.~..~ L~ ~
PLACE OF FILING
C~~rk. ~ COtrt
st lu~ci~ c,ourKy
Fat PNnc~. Flo~td~
TOTAL I ;~~~*
.
I
t
WIiNESS my hand at Jacksonville. FL. ,~~a~
the 2 3 day of Feb . ,~ 9 81
SIGNATI~tE ~ .
VAN E. O'NEAL ~ CHIEF SPECIAL PROCEDURES STAFF tt
(NOTE: Certificots of oA'icer authorized b~- low to toke acknowledgmenls a not esseMid b tlr vdidiy of Notice of Federd Tmc lien G.CJN.
'~ 26419, C.B. 1950-51, 1Z5.)
; PArtT 3-To b~ vs~d for ncondi~q pwpos~s 8~~ Pl~E i~lh~Z
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