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, ~ U. S TRE/1St)RY O~ARTMBdI-- ai~E1Wl?l REVEMlE iERViCE '
lRk1l. !JQ'IA: f9~Ji ~ C.~n~~~ ~F Q~S.F . 0~ F~~Q~ T~ u~~,•+~~.~ (~f
~ (Fornwr1y~Form Oa9) IT~ M rs~d te Rdws~ Tmc 1i~ns wdw S~diM ~.tlSNl. ItC. ~f 1954) ' 6C `
DISTRICT , ' OR ~v Pa~ G~. ~ ~ ~ ~
i hereby oertify t~wt as _t~o the following-named f~mcpayer the requirements~f Section 63251a1, Intemal
Revenue Code. of 1954, have been satisfied with ~spect to the taxes enurne~aited be{ow, together with
all statutory addifions provided by Sectio~ 6321; and that the lien for such i~axes and statutory additions
has thereby k~~~e(~sed. The prope~ of~'icer in the offloe where notioe of internal revenue tauc lien
was filed on ~ , 19
~is hereby cuthor'~zed to make nototion on his books to show
the release of wid lien, insofar as the lien relates to the foltowing f~axes.
NAME OF TAXPAYER '
~~~e a~,~~t, ~l~ a~t ~~ot a~ o~?~. ~
~oe~ oe Pu?cE oF eus~~ss
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TrPE OF TAX /11~ PptlOO ASSESSNIENT QA?E RfflR4iCE NO. AMOIMT OF
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WITNESS my hand at JAQ(~~iYILLE~ l~lOR'I~A . on this. ~
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; ~ 13th ~y ~ Dece~ber 19..,~ I .
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~ Lanrie il. To~linson ' Proaednrea 3ec~os?
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