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! • U. 5. TREASURY PEPARTMENi - ~NTERNAL REVENUE'.;ERVICE
iR~,. ,,,ov. , 96,,, CERTiFiCATE OF RELEA~E OF FEQERAL TAX ~UEN ,
(Formerly F~rm ~69) (To b~ us~d to R~I~es~ iax li~ns und~r S~ctioh 6345(0), I.R.C. 1954)
DISTRICT SERIAL NUM6ER
j~r,~~ ~ oR Bk 92, Page l~Ol~ 126 8
I hereby certify that as to the following-named taxpayer fihe requirements of Section 63251a1, Internal .
Revenue Cod~e of 1954, have been satisfed with respect to the taxes enumerated below, together with
all statutory additions provided by Section 6321; and t~at the lien for such taxes and statutory additions
has th~reby been r~l~set~ The-.proper off~eer in the office where noiice of infiernt~l revenue tax lien
~ was filed on 2~ 1~ 19~, is hereby a~thorized io make notation on his books to show
the rel~use of said lien, inscfar as the lien relates to the foliow~ng taxes.
NAME Of TAY.PAYER
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RESIDENC~ PU1CE OF ~IT~INE96
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TYPE OP TAX AND FERIOD A55ESSMENT DATE ~ RfFERENCE NO. i ASSESSMENT ~
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WITNESS my hand at Jacksom?ille, F'loridat _ on this,
the~__ 31 day of A~~t , 19 b5
DiSTRICT DIRECTOR OF INTERNAL REYENUE BY ~Sig rs) ~ f ~
F. S. Setimidt ~ Special Procedures Se~~ort
(IJOTEc Grtificote ef ~f~'icW ovtheri~ by law to tok~know / rtt is rwt afentiol to ti» wlidiry~f t~his dotument. G.C.M. 26414, C.B, 195Q-1, 125.)
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