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~ F~tw 668 U. 5. TREASIfRY DEPARTAAENT • ~NTERN~~ aEvEwuE SERVtCE . ~ Fe. Om•onel Ui~ B~ Rrco.A.s~ Wl~c
fREV. 8-67) CERTIFICATE Of REIEASE Of FEDERAI TAX IiEN
DtSTRICT SERIAI N0. C .
~M2L' tLr~+in
1 h~rebr c~rtify thot os to the following•aom~d toxpoy~r the ~equireen~ots ot S~ct~on _
6325(a), It+t~rnol Rtvenue Cod~, have be~n sotis(i~d witF rsspect to th~ tox~s enu-
m~ret~d ~Ic~r, toy~thsr with oil stotutory od~itions p?ovid~d br S~ction 6321; ond
thot the lie„ for such to:es ond stotutory cdditi~s !ws th~~eby bee~ r~ltosed. The
prop~r oFfice• in th~ offict wh~?~ notic~ of int~r~ol revenw to: lien wos f:led on
~1~!tpb@Zl,~ , 19~Q.,~ is i~er~by outF~oriz~d to nwk~ ~otation 510
oe~ his books to show the rsleose of soid lien, insofor os the li~n rebtes to tha
followi~y to:~s.
NA#AE OF TAXPAYER ~
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RESIDENCE
~ ~i~ lret !l~sM~ ?~+as • 311~5b
ClASS OF TAX UNPAID BALANCE
%Tux R~turn F«m No.) PERIOD ENDEO ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(o ) (b ) (c ) td ) (e )
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~ > ~~ACE OF FIUNG ~ ~S ~
; • ~ ~1 ~ TOTAI 1
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~ ~ TNESS my hond ct Jacksaaville+ Florida , on thi s,
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2 ~he_2~.day of Marcb. ,19~_ -
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~ ::~,NATURE TITLE
r Jack Durant '.~~~t~__ Chief~ Special Procedures St.aff
'?~OTE: Ct•tllicoN ui ofi~c~r o i.d b~ lo« ~o ~ok• ock~o«ledy~..en+s ~s not •ss~ri.al ~o tM rot~d.+y ol Nonc~ o~ F~d~rof To¦ l~~n G.C.M.
s 2iili9, C.B. 195051. 115.Y ~
~ 800K ~9', as ~
PART 3-To b• us~d for recordiny pu?pos~s