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Form 668 oerNCtr~r~r of n+e txe~nr~rtiE~ ~?~t~ s[~vKe ~ For opr]onal lh. By R«oo?~S~g .BtFce
~~v i-~o~ C~THCATE OF R~EASE !1f FEIIQAL TAX UEN i; it
DISTRICT SERIAL NUMBER P ZOS ~ ~~,q~
O~YRt '1j' -
302889 sk 237 S It~COR~ vfR~F~
i i hereby certify th~t as to t}~ following-nam9d texpayer the requirementt of Section ,
6325(a),` Inl~ema) Revenue Cade, have been satisfied with respect to the tmces erw- ~ t~
merated below, bgether with. all statu*ory odditions provided by Section 6321; and . . .
that the lian for such taxes and staturory oddfions hes therebr been roleased. The
ptoper officer in ofiice whereno~c~ f iM~ernol ravenue tax lien was filed on .
Ma r ch ~ , 19 is her~eby authorized to make notation ~
j)(~
on his bookt to~shs~w the rdease of soid lien, i~ofar as the lien relarFes to the fotlow• ~~v~ .
ing twEes. ~ ~ _ _ -
NAME OF TAXA4Ygt = ~ '
- ~ ~ ~~R~ - . _ _
RESFDENCE ~ ~ ~ - -
- ~ - . _ -
_ _ - . UNPAID BALANCE
KlND OF ~AX TAX PERfOD ENDED ASSFSSMENT DATE IDB~iT1FlfING NUMBBt OF ASSESSMENT
(oj (b) (c) id) lel
124i:dtj 69~0~ ~ C~4-~0-7~ ~
j ~ ~
- Pl..4CE ~E ~lUNC _ ~ _ _ -
9~. ~ 70TA1 s
F~+~l~, ~L ~ ~
. . . . . . . - ~ F .
- _WITNESS my hand at ~ Jacksonville, Florida _ , on tfiis, _
~e 1$th day of June , ~q 75 - - .
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SIGNATI;RE - ' TiTIE ~
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"~''~L'~'~ M ef S ecial Procedures S[aff °
rant ~ , P -
• (NOTE: Ceftifitate of ce, authorized by law fo take acknowledgme~ 't~n~y=1., ial to 1f~yQli i of Notice of Federol Tox tld8 .C.M. =
- 26419, C.B. 1950- , 1 ~Q~K PAGE~ 7 -
PART 3--To be vsed fos reco~diny P~+r~oses