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Ferm ~6e. • U. 5 TREASURY DEPARTMENT •InTERNAI RErFNUE SERVtCE Fa Op~~onol Use e~ Recwd.r.y ON~ce ~
(RE`l. 8-6~J CERTIFICAtE OF RELEASf Oi fEDERAI TAX t1EN k~L~D aND ~E~~Y F~
DISTRiCT _ SERIAL NO. ST. I.UCI~ COUN
1$6283 OR 181 960 RECORD VERIFIEO
i hereby c~rti r thot os ta the ioHowing-named foxpoyer the ~equiramsnts oF ~<<;o„ ~9439"?'
6325(0), Int~?nol Revenue Code, hovc be~n soltsfiad witF~ respect to the toxes enu- q
meroted ~Icw, together with oll stotutory additions provid~d by Section 6321; and 'TO JUi~ 9 PM L• 0~
thot th~ lien for svch toxes and stotutwy additia~s hos ~hereby been ~eleased. TF~e ~/f`~,~~
poper officer in the office whe~s eotice of internol revenue tox lien was (;led or~
_ ILoiamhor 1 , ~9_.5,~ is hertbY outhwi:ed to moke eototion ~pGER POI7RAS
on his books to show the ~eleose of soid lien, i~sofor as the li~n rebtes to the CLERK CIRCUtT C011RT~
foliowiny tox~s. ' _
NAME OF TAXPAYER
Q~~ * ~ ~ T~~
RESI~ENCE
~000 3. ~1 ~qr~i !'t. tl+~M~ ~a~'l~d+r~j~0
CLASS OF TAX • UNPAID BALANCE
(Tox Return Fwm No.? PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSINENT
' (oI (b) lc) (d1 (e)
~3. 6-~0-b1 3A-3-6! ~',l-33,1~~T T1j?•~
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I PLACE OF F!LlNG a~«t, ~it C~l~
I ~ TOTAL S ~1. ~
T!. !ls~~w~ ~3+~• ~ ~s•
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WITNESS my hand ot ~~a~+.+..; t ~p Fta, , on this,
I
the u+h day of J~A ,19 ~n
SIGNATURE E
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MOTE: r~ificote of officer outRwi:ed by (o.r to toke otknowl~dqments is not esssnlial to fhe rolidirr of NWict d. Federol Tox Lisn G.C.M.
26119, C.B. 195P51, 125.) ~
; oQK185 PA~E 1~97
i PART 3-To b~ used for recording-purpoies . .
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