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Form Ht ~' pl ~..-.. `1 ~ iv0. ---------------------
U. 8. TREASURY DSPAB'PI4CtiT ,,,~„~. _. (( i'`"it('`{'["
INT[a1tAL Rt~~YUL e:R\TC~ \T, (. t.~l.'C. tr4~iNTY• ~l-A.
(Revised Mat. 19631
ERT:FICATE OF DISCHARGE OF FEDERAL TAX LIEN(S)
~.~-0 'r1DER II`ITERNAL REVENUE LAWS
i~ED AN ~p~~~ Q to Reveue Ta: Liens under section 3G71, I. R. c.)
~i~-~--uoo(~ UNITED $TATrS INTEP.NAI. REVENUE,
1961 NOV 19 PM 2: 59 ~ ..--------------------------F~Q~~~---- ---- ------ DISTP.ICT.
ROG P IT A ~~
I here~~,~ ~J~~~(~iOw enumerated, heretofore assessed against the following-named
person, firm, or company, hAre ti ``satisfied, together with all penalties, costs, and interests; and that
the lien (or liens) for scch taxes, penalties, et<.., has (or have) thereby been discharged. The propel•
Clerks
officer in the office where notice of internal-revenue tax lien (or liena~/ No. -_3! 55 .was filed
on.._._'..lax__29---------------------------•, 1Q__54__ (record thereof having been made in .__~T,~L-VCIF:_CO1,J2:TY~_ Lien
(T1Ue of book when reoonl
~ok_b,--k~-,gas--l,$Q:1~9D_), is hereby authorized to make notation on his books to show the discharge of
was ma=le end PsRe)
said lien (or liens), insofar as the lien (or liens) relate to the follov~ing tax (or taxes).
Name of taxpayer --------------------------------lielerL_)1t.__Con~tanL_-&_Frank_.~un~ea....-----_-------------------------------------
T~A Tradewinds Restaurant,
Residence or p'.ace of business ----------~21__Qraq~e_-AxEnue,..Et<---Pies,:~,..~'1~z'i.d-a.----------- ----------------- ---
--~- -- Yua oa TAL1elJ I DATE .~53La6YLNT --I AYOUHT Or A.eSE89Y6YT
NATVO of T.ti prLOD f I.taT Y.rcx~tiin
-- ------ ~-------------i---- ----- -- ----
~~~CA__~.5,3.11-8Q5Q~------------ ------------ !-- ----.-3-31=53--------- --- ---12-8-~-----------~- -----~----$$_.3~------------------
'~~,.F?i;t+--(-5-~--1.1-8`~bQ~------------- ------------ ---------fz_3~-53---------
--
----11-~-53----------- -
-----------35_.-84----------------
'~r •" 2-711~~-------------- •------- ' ------1.2=3153--------- -- -----2-?~-~~+-----------I
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,, .,~,~f,~„~g,lny hal,d at - --- - --
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Jack;;onville,-.F~or~..a--
- --- - - -- - - - -- - --- - ---_, on this,
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the __----_2Oth --__-_ da}• of _ --
- October_ -. , 1~S1}_
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T6: Clerk, Circuit Court District Uir o/ Interns! Revenue.
~T. LL'CIE COI)1TY - - %
Fort i'i~.-ce, F1~rida . By --- - -- --- --- ~ - -- --- ----------------
fat~ct - m~
Collection Officer
(hole: G-tiAcate of officer authorized by law to take acknowledgments la not esaantial to the va':Idity of Discharge of
Fede;`.Il Taz Lienfa;. G. C. M. 2u419, 1950-1 C. B., 1?.6.)
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