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, I~e~~ bbd• U. 5 TREASURY DEPARTMENT • iNTErtH~i aEveyuE seRVicE Fo~ Op~.a•ot us~ 9r 4«o.e~~.y 0/bce
; (REY. &67~ CERTIFILATE Oi REIEASE OF ffDERAI TAX ~,IEN ~
' ~ISTRICT SERIAI N0. ~ ~ ~
; ~ : 19209! _ - R ~ .
~ /lE~011~ YE
t1i '
~ ~r• y c~rti r 1 os to ths (ollowmg-nam~~axpoy~r the r~qui~~m~nts ol Sact~p~
; 6325(a~, (et~r~ol R~v~nv~ Cod~, hove befn solii~i~d witb r~sp~ct to fhe tox~s snu-
I .+n~~ot~d 1MIa+r, tog~~her with oll stotuto~r odd~~+ons provided by S~c~ion 6321; ood
~ thol the lien for sueh to:es ond stotutwy oddilions has +lN~~by b~en hleos~d. Ti~e
; pro~~ olfic~r in th~ offic~ Wh~r~ ~otice of int~~nal r~ve~w tox li~e wos (il~d pn .
~~i lS , 19~e
- is F?•r~by o~+ho.i:.d ~o ~aoks noro~ioe
i on his looks to sho.,r the rel~ose o( soid li~n, insofo. os the li~n r~bt~s to tM MO~
~ fo{lowin~ t~x~s. ' ~ l~irll
NAME OF TAXPAYER - '
; • ~
RESIDENCE .
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j CLASS OF UX UNPAID BALANCE
1 (Toa Rtturn Fwm No.l PERIOD ENDE~ ASSESSMENT DATE IDENTIFYING NUMBER : OF ASSESSIiAENT
(a) lb) (c? (d) (e)
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` PLACE OF FILING
~ ~ ~ TOTAL S
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W I TN ESS my hand at J~1C1u~avill~ ~!'isrida , on thi s ~
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the 30tY doy of OCtob~ ,1970
SIGNATURE TITLE
(MOTE:.C~.Nf~ce+~ e( o11ic~. e~~iw~ y ro ~~k~ eekn~wl~d9n~~ms ts no+ ~s~~mi~l ~o ~M .olid+ry N~ttc~ ~1 F~d~.~l Toa ~~~n G.CJiA.
?N19, C.B. 19SOS1, 125.)
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rART 3-To b~ u:~d fo? ncordinq purpos~s
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