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F~, ~j U. S. TREASURY DEPARTMENT • N+Tear~~~ qEVCt+ut seRV~ct Fo. Oena,o~ :J. e, R~co~evy Off~c~
~ cREy. ~e~+ CERTtFICATE OF REtEASE Of FEGERw! TAX.UEN ~
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DISTRICT ~ SERIAL NO. ~ ~
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~i~i~ i Utl~ ~1a Y11U0 -
( h~rtby c~rti(y thot os to th~ IoUowiny-eom~ to:poy~r the r~qvusm~nts of S~ction ~ R~~ ~J
~ 63lS(o1, Int~rnol Rev~nw Cod~, hove be~n satis~ied w~tF~ respect to th~ rox~s cnu-~ ' ~ `
, rn~rot~d ~te«, to9~tl~er with oll stotutwy od~itions p.o~~ded by Sectia? E321; onA L R CIRGW~ ~
that ths lien fw svch toxes ond stotuto~r oddlticas hos thcreby be~n ~elecsed. T~~ ~~I~~E~~
p~op~r offic~r in the oific~ wh~r~ notic~ o~ int~rnol r~venue to: lien wos 491~d on
~ .~U~ 23~ . 191~ - is h~reby outhoriud te n+ok*noroti ~
on his books to shaw the r~bose of said lien, iosoFor es ths ti~n ~ebtes to t~ •
Fo~~~.;~ ro=~s. - ~543 `
NAME OFTAXPAYER '
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RESIDENCE
t~AMr
CL/15S OF TAX UNPAIO BALANCE
' {To: R.turn Fo.m No.) PERIOD ENDEO ASSESSMENT DATE IDEr.TIFYtNG NUMBER OF A55=55MENT ~
~ (o) lb) (d1 ts)
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P~ACE OF FILING~ ~t ~
~ ~ ~ TOTAL S
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WtTNESS my hand at Jscksortvil]A Floridg on this,.
the~h_dcy of Apri2 ,19 71
SIGNATURE TITLE e~~~ ~
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MpTE: Ce.ti(icof~ of olfic• w ~~d by lor ~o ~ok~ oc4no•l~dq~eerws :s no~ •ss~m~ol to ~h~ ~olcd~~y .f N.~ic• et F•d.~ol Te: Li ~r G.CJiA. ~
~ 26I19. ~-B. 195051. 125.) 88 ~
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PART 3-To us~d for r~co~ding purposes
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