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HomeMy WebLinkAbout2892 s ~ . . ..r~:ri.:-... - 3. - , ` ~ - . _ . t'. - 'i L_.:?t-~ -r' -r ' . ; ~ , - " . ; . ` , . i F~ ~ U. S_ TREAKIRY OEPARTMEI~T'• ~1TERNAI REyENUE RVICE Fw ~raMl Us48r R~cerdrg ONi(v ; ceev. e-a» = CERTIfiCATE OF REIEA'~E ~;F~ERA1 YA~~~N = DISTR~CT : SERIAL'~10. ~ ~ y .187+?81 ~181 ~P-25t5 ~ ~coo~a v~tr o ~ I.h~~~br eKtify that os to th~ followieq-nomed~toxpqy~~ fh~ navirtari~ts ef S~ction - ~ 6325(0), _i.,~+tKnal Rev~nw Cod~, !ww b~~n sqtl~fi~d with nsp~ct to tM toxis ~nu- - ~ ~rot~d .Mlow, toqethtr with oll stotutqr od~~ions orovid~d by S~etlon 6321; asd - ! thot th~ ~li~n for such tox~s ond statutorr add~ons ~os !hinbr b~ae r~l~os~d. TM prop~r oKie~r in th~ oEfie~ wMt~ noticf of ~nf~~nol r~v~nw tex li~n. wos fil~d en de~sbtl~ 23td , I~Q,~,:ay Merby autho~i:td w mok~ eototion ~~MGA oA his books to'show th~ ~ebos• of soid I~n, insofor os tM li~n ~~btei to t1~ «f+~h~ j Foliowi tax.s. . ~ ~ NAME OF TI~PAYER • ~ _ - ~ ~ ~ 1~ ' _ _ . RES~DfNCE*. ~ ~ ~ C~11S5 OF TAX - ° ~ ' UNPAID BALANCE ~ (Tax ~~turn Form No.) PERIOD ENDEO ' ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT I (o) _ l?) (c) (d) (s) i ; ! ~ i ~AI~ 1~•)ir~ ~-i~y ~1~1' - ~ I ; E ; _ ; i ~ • ~ - ; ~ I ~ . - ~ i ~ , f PLACE OF FIUNG ~ ~ ~ ~ @~ TOTA.L i ~ ~ ~ 1~~ l~wMj ~ ~ . ; ~ WIfNESS my hand at Taelcwnnaill~~ Flerida , on this,. ; the_~_doy of~.n~.h.~ ,19 T~ SiGNATURE TITLE ~ Lll'a~_ ~ ~ MOTE: Gni(ic~ • c~. w~1+o.ts•1 ~r low ~o rok• ecknewl•do~.M• is ne1 ~iseMi~i ~e tM •eli~i~N~~ F~J~.~i T~¦ Li~n G.C.M. ?6r19, C.d. 193051, - ~~~Qp~ ~ ~ ~ rART 3---Te bs vs~d for ncerdin~ purpes~s ~ - _ ~ - rs=?"~~~ . _ '~`K~ a