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HomeMy WebLinkAbout2320 ~ ~ ~ , : - - _ . . _ . ' . . _ - ; t. 203'7~5 ~ ~ ~ ~ - . i F.r. 66~ U. S_ TREAStNtY ~EPART1ilENT - wiER'lu?~ R~rEwuE sERVrcE _ F« qr...n.r us. e R.~o.e op:c. i taev.ab» CERTIiItATE OF REtEASE Of iEpERAI TAX~1fEN ~ ~ ~ DISTRICT ~ SERIAL NO. p~ A ' j ~~~i~ S~ j,~ 18?~40? 8-179 P-1763 ~ X ~ 1 Mr~b c~?YE thot os to tM followin' -nom~ ~tox Y ~E~ ~ r J Y. ~ por~r th~ rpuit~n~ts of $~ttia~ , 6325(a), lnt~rnol R~v~nw Cod~, havs b~~n spti}fi~d witb r~spect to th~.rox~s ~qu- m~~ot~d Mlew, to9eth~r wit6 all stotutoty od~ifions provid~d by S~ctioo 6321; eqd J thet th~ ~isn for sueh rox~s ond stotutwr oddiNons las thir~by M~~ r~l~astd. TM ~ prop~r otfit~r in th~ ofiic~ wh~r~ notic~ oi int~rool ~ev~nw tox li~n wos (ibd en J , A11Q11$t 29tt11969 is h~nby out6o`i:~d to aake pototion s on his books' ro sl~ow th~ «leos• of so+d li~n, insofor os th~ li~n ~~k~~s to tM CrG~~,(~/~ . followin~ taz~s. . ~ . D~ NAME OF TA~IPAYER - ~ . ,~l" ; ~ ~ ~!j ; ~ RESIDENGE ~ ~ t~'~j !!~'~M~ ~'~l1ri~~~ ; - • CUSS OF TAX UNPAID BALAPlCE (Tax R~twn Form No.) PERIOD ENDED ASSESSMENT OATE IDENTIFYING NUMBER OF ASSESSAAENT . ~ (o ) lb) (c ) (d ) (s) , ! , ~i ~ ~ I ~ ~ . ! ' ~ ! . ~ ! I j ' i i i { ~ PLACE OF FILING ~ i ~s'~~ ~ ~ ~ ~:1 TOTAL S ~ ~ ~ ~ . WiTNESS my hand at - T~ -ti~nvill~~ Flnr{da , on this,. ; _ ; . ~ ~ the~th dey a4 ~c~m~r ,19 7A " ' . ~ ~ SIGNATURE TITLE ~ , ~ (NOTE: Grtiiie~h ~1 of(ie• •a by I~.r ~e ro4~ eckno..l~dyn~nis ~s rw~ ~~~~m~s re t1r veliAitr ~F Ne~~c~ ~ F~d~~ol Teu Lie~ G.C~1, ~ ~A119, C.B. 19S~S1. 125.1 t~ ~ ~ ~ ~ART 3--To b~ us~d for ncordin~ p~rpos~s • . ~ - - ~ a~ { : ' t,~~ y "~-""`~'a'r ~ ~ v ~ , ~ ag ~ ~ _ ~,.~~~~~~:~s ~ _ _ _