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Form fi6R Department oi the T~easury - internal Revenue Senice
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;Rev. Sep!ember 1978) Certificate of Release of Federal Tax Lien
District Serial Number Fw Optional Uss Dy A~cwding Ottice
495273
JACKSONVILLE O.R. 336 PG 601 ~3 ~ Q
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I certi that as to the foltowin named taxpayer, the requirements of section 6325(a) F'• l'~~ = c-. I
fY 9' S.'.!t'~FfL.y''.•. ;
~i the Internal Revenue Code have been satisfied for the taxes listed below and r~~=.k r~,
for all statutory additions. Therefore, the lien provided by Code section 6321 for C:t~:r: ~:c~:,,;r~ t-~- ~
these ta~ces and additions has been released. The proper officer in the office
where the notice of internal revenue tax lien was filed on August 6 ~
19~Q, is authorized to note the books to show the release of this lien for C~~
these taxes and additions. v
Name of Taxpayer
Vanderburgh Johnston~, III
Residence
I11 N. E. Caprona St.
Port St. Lucie, FL 33452
I Unpaid Balance
~ Kind of Tax Tax Period Ended Date of Assessment ; Identffying Number of Assessment
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; (e) (b) [c1 (d) (e)
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j 1040 12-31-76 ~ 04-02-79 265-61-7122 486.78
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~ Place of Fiiing .
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Clerk of the Circuit Court TOtal = 486.78
St. Lucie County Courthouse
Ft. Pierce, FL 33450 ~
This certificate was prepared and signed at Jacksonville, Florida , on this.
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3 the 5th dayof August ,19 83 ~
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Signature Title
A. W. Sendler Chief, Advisory Unit _
(Not~: Csrt~fice!s of oflecer eutAor~zed Dy !aw fo teke acknowlodflments is not ~ssential to the validity o! Notic• 01
Fsdsra/ Tsx c~.~ G.C.M. 28119, 19541,C.B. 125.) cs ccc 8-5-83
Pert 4- To be kept by SPS ~orm 668 (Rev. 9-78)
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