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FOrm 668_ OE?ARTII~ENT Of YNE TREASURY-INTFfUtA! fiEVENUE SERYICE _ ~ for Opl"pnol Use By Recording Offlce
(REy. ~a~i) - .CER?~PUTE Of RELEAS~OF FEDQG! TAX"1~EN ~~p ~M;~ ~
~~.LUCik.~ ~ Y I.Ar
DISTRlCT ~ E qL NUMBER ~
_ _ ~ . ~~832 sic 237 Pg..2978 : ~ ~4,[~ ~~li ~
URT
F=r,+?f~"!'/f~lElEt~..~...,..r+...+
I hereb certi that os to the followi ~ nartied tax •
y fy~ ng• pay~er the ~equiramenh of Sect~on '
6325(a), internal Revenue Code, have been.svtisfied with respect to the taxes enu- f w
_ meroted befow, together with al) statutory o~{ditions provided by Section 6321; ond ~ I~ I? ~4 P~ ~
~ that the (ien for such toxes and statutory additions has thereby been released. The ~ - t
proper.of~'icer _in the of~ice where notite of internal ~venue tax lien was filed on _ ~nQ~~ ~ ~
Mareb-31 , 1915_~; is hereb authorized to niake notation Zj~~
on his books xo show the release of said lien~ insoftir as the lien relates to the foliow- _ `
_ - ing toxes. , . -
~E~~~ ~ ~a G. ~t~- - ~ - '
RESIDE~ ~ ~A ~f.I S~ PQTt
~ ' ~ ~~Q~ ~ : _ '
" ~ UNPAID BALANCE
KIND OF TAX TAX PERICD ENDED DATE OF ASSESSMiENT IDENT{~ING NUMBER OF ASSESSMENT ~
- ~a) , (b). - l~) (d) (e)
I~040 _ I.~?3~-yC} 0'~~+i-7~4 Q34-3i4-#3~68 _ 2~02E3.~fi
1440 1.2-31-6+4 Q8-I9~•'~4 t~4-3~J-8968 ~A3~~5
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PLACE OF FILING ~ -
$T. LtlC~E COil~'Y - TOTAL $ 2~~~~
- _ Pt3tiT ~ 110RiD~1
WITNf$$ my hand ot -j~~~sonvill~.,=8lorida ~ ~ , on this,
the 15tt~ day of_ Zinv ,~19_ 75 - ' =
SIGNATURE -y~ T1TLE _
- J ~rant~~-(~ - - _
- Ghief. Special Procedurea Staff -
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(NOTE_ Cert~ officer auPhorized by Irnv to take acknowledgments is not essential to the volidity of Notice of Federol Tax Lien G_C.M.
26419, C.B. 19YJ-51, 125_) - ~ ~ ~
• hds
- PART 3-To be ~ssd for recording purpo~~" -
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