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F~n~'bbs U. S. TREASURY DEPARTIiAENT - INTERNAI RE(ENUE SERvKE Fa. Op~awl Uu 8r ~~M9 p~~c?
(REV_ &67) CERTIFICATE OF REtEASE Oi FfDERAI TAx l~N ~ F O AMD RECOAt~D
' DISTRICT SERUI NO. , 1~CIE GOUNIY
ROCER POIT1t~S
O~ l7~ ts Ztf3 le,~AO~ ~~tx C~Rt~it~ ~
( htr~br c~rtifr thot os to th~ foliowiny-oam~d taxpoy~r d,• ~.a~we~~s o( S.c~~o~ ~~~~'~9"'~~~
6325(0), lof~rnol R~v~nw Cod~, hove M~n sotisFi~d with respect to tbe tox~s snu-
m~rot~d b~low, to9eth~r with oll stotutorr odJitions p~ovid~d by S~ction 63Z1; aad
thot the (ie~ for such tox~s ond stotutwy odditiaes hos th~r~by b~~o ~~Itas~d. TM 2p4611
prop~r o ice the offic~ whtr~ notice of t~r~ol rev~eu~ tox_li~n wos fil~d ioe+
J , 19_S~is h•nby authoriz.d to mak• noto~ion
on his books to show the releose of said lien, insofor as the iien r~totes to ths Q~ Cti~
.~~~~ri
followinq toxes.
NAME OF TAXPAYER
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RESIDENCE
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' ?~s~t t3~oe3+d~ .
CUSS OF TAX UNPAID BALANCE
(Taz R~twn Form No.) PER~(?D ENDED ASSESSMENT DATE IDENTIfYING NUMBER OF ASSESSNIENT
~o) (b1 ~c) (d1 ~e~
2?o1rD 1~#3~65 e-~S-61 4u~-oT-55"r0 ri1A.b
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~ WITNESS my hond ot J~4~~~ Fl'~`j~ , on this,
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S{GNATURE TITLE
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~ Q~t ~ t!'OO~d1II'M stit~
~ (NOTE: t~rtificot~ of oific~r r i:•d by lo.. to tok• ocknowledyments is no~ ~ss~M~ol ~o tM vol~di~y of NWic~ of F~d~rol Tna Lien G.C.M.
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