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Foa~ 668 oENUtt-MfM Of ?-E nEwSUtt-arTEedAL lEVElIUE SERVKE for Op+ond U~e Sy Recardng OR'ice
~aEV. ~a~~) C~~ATE,Oi RBEASE Of ~Al TAX t18i
DIST SEWAL NUMBER . ~~
_ ~p~=~ 291230 b-231 p-2339
I hareby cefify that os ro the following-named ta~oyer the requiremenh of Secfion
6325~0), Internal Revenue Code, have been safisfied with respect ro the roxes enu-
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stahrtory add
ons provided by Snction 6321; aod - ~1 ~ 9;~~'_ ' 0
that the lien for such taxes and statutory addi6ora has thereby been releosed. The ~ - ,~' =
proper ofi'icer +n the o}i'ice where notioe of internd revenus tax lien was filed on
Sept 11
74 F4~Q Itr fif p~
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, is he~eby authorized to rtioke notation ~~~
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on his books ro show the release of said lien, insofor as the lien relotes to the folbw- CIERK CIRCWI ~T
~~ t~~' RfC(:RR ~•s~o~r
I~R
NAME OF TAXPAYER
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RESIDENCE ~ ~
~l~e'tia ~K7Z
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K1ND OF TAX
TAX PERIOD ENDED
DATE OF ASSESSMENT
IDB~ITIFYING NUM68t ur~Pan e~-uwcE
OF ASSESSAAENT
(a1 (b) kl (d1 - (e) "
iws ~ t-si-» os~s~•~a ~ass.~.~ ~ ri. i~i. so
-1ACE OF FIUfVG
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WITNESS my hond at JACKSONVILLE , FL ~ o~ ~~~
the 20 doy of Feb , , ~q 81
~ 5lGNATURE I -- 11T1E ~ .
VAN •
(NOTE: Certificate of o~cer avtlwrized by law to take «knowledgments is not asentid ro the validity of Notiu of Federd Tox lien ~
26I19, C.B. 1950-S1; 125.)
~ PARt 3-To b~ used for rccordin~ purpos~s ~~~ ~~~
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