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~ • Fe~A dsa • U. S TREASURY DEPARTIIENT - IMTERNJIL,R~vEMUE sERVILE fa Qp.,orol Use By R~card.ey OH~ce;
i cRev. s-ar, CERTIFKATE OF RELEASE Oi FED~R~I TAX t1EN
~ DISTRICT SERIAI NO. ; - AN~ ~~,y ~
I ' 8 ~Rf.CORn VERlFtEO ~ ~
1 . 1 hertby ctrtify t as to the (ollowin9-nan~ toxpoy~r fh~ rtauiremie?fs of S~cfion
~I 63Z5(a), Internoi Rrvenw Cod~, hove b~~n sotisii~d w~tl~ r~spec~ to ,ax.s e~~- i9i6~'4
! m~roted b~ic~r, to9~th~r with oll stat~tay odditions provided br S~ction 63Y1; ond q O
i thar th• (ien fw suc6 toxas ond stotutwy odditions hos thereby been r~l~as~d. Tlie O~ ~7 ~ ~ ~ i ~
~ ~ prop~~ ofiicer in ths o(fice whe~~ notic• of int~~nol ~evenw tox li~n wos fil~d on ~
9],- 197A . 19~~ :s h~roby outhwi:~d to mok~ nohrion ~
~ on his books to show the ~el~os• of soid li~~, insofor as th~ li~n r~kt~s to ti~ ROGER POtTRAS~
~ followiny tox~:. C~R~ ~RCU1T C~U~t.~
~ NAME OF TAXPAYER '
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' RESIDENCE
; ~ ~irr~ ri~, ltie~•~90
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~ CLASS OF TAX UNPAID BAI.ANCE
f (?ox Rtru~n Form No.) PEFt10D ENDED ASSESSMENT DATE IDENTIFYING.NUMBER OF ASSESSMENT
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~ ; PLACE OF FILING ~ ~~is
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~ ' Jacksonvflle~ Pla. ;
" WITNESS mr hand et , on this, ~
~ 9th March 70 ~
~ the doy of ,19 ~
~ 3
~ SiGNATURE TITIE ~
J K DURANT CHIEF-SPEC. PROC. STAFF tt ~
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MOTE: G.~tfieoa of offie~r ourlwri:~d by (ow to toke oeknow~l~dyae~nes is rat ~ss~nriol to t1» ralidirr of NMie: of F~d~rol T~ Li~n G.CJd.
~ 26119, C.B. 19S~S/. 125.) ~
~ a R ~rhis instrument pre ared by Jack
~ us~d f
onior~}it, 400 W. g ~t ee~. J~~l~~~n-
n~purpos.svil~~, F~orie~a
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