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Home My WebLink About1774 . a , • ~ . ~ e.._.,.~.~...~.~...~...-. v.-r--'°.--..-~---:~,.-.~.y ~ r ~~~`s"""-~~_y~m~• N?+~'i~n~"-~- ~a~- . _ . _ . . . . " - ' ' _ . ' ' . . `a;~., "f- ~~s'. . , , _ ~ , .t . . . ~ ~ ~ . - • ' v ~c-, ~ ~ . fy~ ~ ~ U. S.IREASURY OEPARTNENT - INtEit~U?l RfYENUE ~RVICE _ $ _ Fa ~:i~1 A~e«~ Ofiio~ cieev. i.aA ~ ~lT~KK~TE OF~ IEASf Oi I~~ERAL TAx'!~N ' ~ ! . ~ t . _ OISTR T " SERIAI 0. - ' .r.s. ; . . ' . , ~ s ~AY e~rti t as to tM iollarin~.nea~toYpoy~~ tM nquK~~ts of S~ct~ i~' . _ 6~S(o),.,Inhrn~t R~wnw Cod~. how b.M s~.ti~fi~a:with rospeet w'1~ tax*s RECQRO ~0 = ~ w~rot~ ~ilaw. to~fMr wilh el) shtutot~r ad~~ions,~p?ovid~d b~i S~ct~en 6321; e~d = ~ thilt tM-~ien fw sueh tox~s and stotutary; bdditions hei thinbr be~n t~l~osa~. Tiw ' • t ~ :~r eHic~~_ in SM oHiu vrh~h M?ttc~: of i»mol'. nwnw tox li~n; wes f3bd 0~ , 1~.:~i I+.nbr .u~ho.is~ *+a welc~ nototi~ - on his bosks to=~ho+r tM ~~I~aa~ of~ s~id li~, inso(or ~s t!r li~e ~~kMS to e~ : hllart loa~s. ~ ~ ; ` ' ROGER`~'OIT NI~NE :OF T . PAYER . ~ , : RK ~IIS~~IT ~ . . . _ " ~ . ~ . g, - , - RESID, rb , -a ~ - _ ~~~1~~ ~ aM ~ ~ - C ` SS A • s., > ; ~ -UNPA7D 6ALAti~E - (To~c ~t~turn Forw.No.) PERIOD ENOED ~ ASSESSMENT DATE tDENTIFY1NCs NUMBER OF ASSESSiAENT _ . (a) ~b) - ' (d) t~) ` _ ~ ~ ' ~ ~ 'R~ ~ ~ _ - : . ~ ~ PU1CE OF FILINCs ' ~f ~ ~ TOTAL i ~ ~ ~Z~~ . £ JaC~ ~~B ~ ~O!`~di , WITNESS my hand ot , on this,. th• 2~ dqr of J~ ' i9 , L SIGNATURE TITLE Jack Dm~ant Chiet . Proa. - ~ RiOTE: CwtiHe~ feM wrtlwi ?y Imn to xknwl~N~~s t~ ~s~nti~l re ri+~ ~~li~iryr ~f NMtc~ ~f F.Mrel T~s Li~n G.CaA. ~H, C.s. 19SpS . ) ~ ~ART 3-Te b~ vs~d fer ncondMgwTos~s G `~~'^~'Y:~#~.~ :_'7 . . - _ '