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HomeMy WebLinkAbout1865 . . : ~V..__.- - . - . _ . . _ _ -r - • . _ _ ' . ` ~ ~ Fotm 668 OEPM7MEN1 OF 7tiE T4fASUi'Y-NTE~hU11 REYENUE SERIIlCE . - - for Oplionol Ufe Br Recwd+~g OH'.ct l~Ev t-~ol tERTIHGTE Of RELEASE 4f fEDBtAI TAX t~M F,L-~ 1.~+~'~~p ftq[Q DISTRIG? • - . SERIAL t~(UMBER - - 1T'4~~C1~ ~t1UN~Y ~`l.A, - 296823 8~234~ P 114$ RG~i~? Pd~i~~S ~ 6 GI.~RX u: ;GU1rt OQU~1 =1 hcreby certify thot as to the'following-named taxpoyerthe requirements of Sectiom ~ p~''~~~ Y= ~~~~€;'~*'~'~*"t , b325(c~,-lnternol Revenue Code, have ~~e~ sbtisfied with respect to the taxes etw• - ` - merated below, togethar with all_ statutory additions,provided by Section 6321; und , M~ ' iiict the lien for such taxes and stotutory addi~ions has thereby been released. The ~ proper officer i fhe ce whera notice~} ~~~ernat ~evenue- tax (ien was filed on tin~~~ ~ ~eC ~ ~ 9-~`+ ; is hereby authorized to triake notuiion ~r,)p _ on his books to show~ihe release of said lien, insofar as the lien re!ates to the follow- ing taxes.' . ~ ` - - NAME OF TAXPAYER - - ~ ~ ~ =M ~ _ , - . : - _ . RESIDENCE 3~ ~ ~ _ . . _ . - ~i. ~il~ - - - UNPAID ~ALANCE ~ _ KIND OF TAX TAX PERIOD END:D ASSESSMENT DATE IDENTIFYINCr NUMBER - ~ OF ASSESSIAENT - tb1 id1 (e1 ~ ~3~i-7~ ~i ~~ii~E~ il,a0.~ PLACE OF FlItNG - - C~erk. C~itCt.Rt Cc~ctrt _ L~;+a C'.~unry - roT~. ~ Forf t~ree. Fiarkti - _ - WlTNESS my hond ot Jackso~ville, Florida , on this, ~ 15th ~y of May - , 19 75 - - SfGNATIfRE ' - TITI~ _ ~ - : - : - ck Durant - - Chief, S cial Proceduxes Staff - (NDTE: C ~ficafe f ofE'icer authorized by low to take ocknowledgmmh is not asentio! to the validiry of Natico of Federd Tox L'~en G.C_M. : ' 26419. C.B. -Sl, 125.) _ PART 4--To bt retaitsed 4~r SpS hds