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HomeMy WebLinkAbout2405 . . - - ! ~ . ~ - ~ ~ F~tiw 66~ U. S. TREASURIf DEPAR~MENT • INTERNAL REV~NUE SERVICE Fr QMw»I Us~ If R~c`Iap ON~n ~'{Rfv. e-6» CERTIfKATE Oi RELEASE Of F~ERAL TA~ LiEN ' ~ ; _ OISTRICT SERtAL NO. ~ 1~ B$L P2 ~LE IE CO~i~I ~ 1 h.r. r e••t y t t os to ~M lollowi~-rww~ texpy~~ 1h~ r~quir~~nts of S~cRion ~EII'01 r ' 6325(0)~ (ot~rnel R~wnw Cod~, !ww b~~n s~is~i~d with r~sp~et fd fM tox~s ei~u- ~t~ C~~r4~~~ 4 w~trat~d_b~lo~.r, to4~thtr with ail stetutorr o~ifioe~s piovid~d by Seetio~ 6321; 4nd OrM~~i~O - tiwt th~ li~.+ fw such rox~s ond stotut odditions hes th~r~b b~~o r~l~as~d. th~ i ~ep~~ oilic~r ie tht o(fic~ wh~r~ noti~ o~~T~t~~Ml r~v~nw ox li~n wos fii~d.oa ~ i~ Nnvwte~ l f~~ , 19,~y;;,:is i~Keby out6o~i:~d to nak~ netofion ; ~ on his books ti shorr th~ ~tltas• of soid •Ifiin, insofor os tlw li~n r~btes to IM fellowin~ taxss.` . NAIr1E OF ~XPAYER . ~ , > .y,a . ~ . ~ . ? • , a.; ~ . . . _ ; o,,. . 4 ~ ? - . _ ~ ~ , ..,r r . , , RESIbEIiC ' _ • ~ n ~ GLASS A " UNPAID BALANCE i (Tos R~turn Fws No.) PERIOD ENDED. ASSESSMENT DATE - IDENTIFYING NUMBER OF ASSESSMENT , • (o) lbl !c1 (d) I~ ~ ~ ~ ( ~ l I ~ ~ ~ ~ I ~ ~ ~ ~ ~ _ ~ ~ .4- f. . ~ , ~ _ ~ ~ - ~ - ~ : ~ , ~ ~ d • _ ~ . - .>..a..,:. _ , _ . - ~ E. ~ ~ _ - ~ . ' ; ' . , . . , ~ PLACE OF FILING c 4' ~ ~ ~s TOTAI i ~ ~ ' ' • ~ ~ ~ ~ WITNESS mr hand at Jacksmville~ Flerida ,~*;s . ~ ~ ~ ~ ~ ~ thf~Q?.~LdaY of r1y ,19 ?l ~ ~ SIGPtATURE TITIE ~ ~ fNOTE: C~.~:fice+~ e~ oilic~r ev~h~.is~L br lo.r ~o tok~ otwnev.l~dyrwent~ 7~ net ~~s~nt~el te ~M re ~A~~r of Na~e..l F•~«.1 T.¦ Li~n G.C.M. 'ti 26~19, C.S. 19SOS1, I~S.) . ~ PART 3--To b~ us~d for r~cordln~ purpos~s ~_g: ..-=--_.T. . _ ~ - ~