HomeMy WebLinkAbout0146 _ . . - - - ~ S _ , . _ _ . - - - . .
V
?w~ ii~ U. S. ~REASl11CY OB~AllTM9$~ - NiIE~LWL RlVH~lE SERVICE Irr ONird IM b R~o~ OI'1~w
NOn~E oF FED~Gt. TAx uEN ut~t utTERNIII REYQWE iJIMS r;~eo anro RECO~oEo
~ s ~uc~~ cat~nrT~•. F~.a.
fiECQ~!? VER(Fl~n
w~,an~ ro th. w'o+?iston. d s.et~on. a921. 692~, and a929 of fh. ~nNrnal IE~weK,. cod~?
noeio. b ~»r.b~? ~iv~, that lM~. ~,a~r. bssn a~t.a una.r 1h. ~m~al kr~~w. law~ of ,h. 1~! 1MA -S M~I 9:~ ;
united stat~s a~atrar ~hs toliowing-~wn,ed wxpara. tmw I~ ~+a ~ w~Irtes) whkh .
oNsr d«nood s« poy~n~! th«.of r«rwin unpo~d. an~ ~har b~? wrn,~ of d» aboM.-nant~w±d R 0 G E R P G i T Z A S '
,to,,,tes tl,. a,n,unt of saM ,mo~,, ,oa.ehx wt~h p«whN., uM«.~t, ana co~ts ~i,a+ mar «erv. ~L,.RK CIRCU(T COt1RT ~
i
n a d d
i
t i o n 1 F~
M
O, i s a t i e n i n f
a r
o r o
f f h ~ U n i t d S
I
O N a u p o n a 1 1 p r o p~ r h a n d d
p h s t
o P~' o P~ Y j
b~l«ginp w mid ta~ay~. z
NAME Of TIIXPAYBt ~~~~Q(~ }
~ ~ ~11~ t~l~ 3
Z~~
RE5109JCE OR PlI?CE OF BU51t~
!24 sww~ r«u~ sc~r~..c
t~st li~s+e~, ~l~r~ia ~
awss oF T~uc urwa~ sn~~
R~ ~ r~o~n No.l penoo e~ ~.~sessMear or?~ ioam~rprc+ ~rt oF ~ssess~
lol Ibl Id I~ le)
~
'i
I
f41 ~isl~l~ii~ 0l~~O~i~ E2•20•i~ . ~l16~~10 ~ t~0.i4
~ f
~
~
it/1~CE Of fillf~ld
Ql~l~~ Ci1S~Mu CMle 10~A1 =
•t. Lrsl~ ONrt~
T~st *l~s+o~ ~ tl~sf~i~
W11NES~S my hond at t~..c *.t~ ~..~ti~ ~t,.~~. ` - o~ thh„ ~
,h, )s+~ ~ ltst+~ , t9N
DISiRiCT q~C1~ORCE N~fIEMIK ni1! i
t
J. M A. '
R~'~b GeM/~m~ d of(~ar arAialyd bq low to ?a4~ odr~owMdPaMw N no1 MwMld to th~ v~q ~1 tiMa N twiwal Ts Wn OeC~ ~
~Nt1. C.~. 11a0-S1. 12S.j ;
~ T.~.~~,~.«~. ~~i'~6 ~ i.45 }
- K _ - ~ _ ~ f~~
~ _ ,
_ ~~~-~~.~~'4, ~ -