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--Form SSS DE?nRiMEwT Of iNE ~lfASlnt'-NTEb~1~l REYENUE SENKE Fo? Opro~wl Uf~ 6p R d~neJ 01~c~
i~v. i_~o~ CER~fiCATE Oi REIEASE Of FEDERAt TAX UEii f o~Q~
D~STRtCT SERIAI NUMBER ~ ~~~ER
~
K b~ B~ .~E,? atE~K CIACWT~
I hereby cert~fr rho? as ro rhe follow~r?g-named toxpoye~ ~he requ~ren,er??s of Sec?ion ~C~ ~RIFIEO
6325~a?, Internal Revenue Code. hove been satisfied with ?espect ro the toxes cnu-
merated below, togeN?er with o!1 statutory odditio~n provided br Section 6321; and ~ 5 Z~~~1 ~
thot tfie I~en for such taxes and sto~utory oddifions hos the~eby been rcleosed. The
proper oi#'icer in the ofFice where notice of inlernol revenue toz lien was filed on
-=:==~i.1 . 19~~. a henby autho~ized ro niake nototion
o~ hn books to show the releose oF soid lien, insofar as the lien relotes to the folbw-
ina taxes.
NAME OF T/1XPAYER
eiel~ra ~ Alis~ J. llasipi
RESIUENCE i`~ s~ K~ stl~~t
~wrt t1~s~ea~ ~la. Si~
UNP/UO BAUNCE
KiND O~ TAX T/?X PERIOD ENDED ASSESSMENT OATE IDENTIFlfING NUMBER OF ASSESSMENT
i (al fb1 kl (dl (e1
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14~0 ls-•31-4! Ol-l~-Tl ~00-~-i0l1 - ~~f.la
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~ PU?CE O~ FIUNG
~ Cl~l~ C~1'~~t C~IIlt TOUL S u• Is
st•
~ nr! ri~. ris.
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~ :1;T~:ESS my hand ot ~~s^r~~n:•il~e~ z'l~ri~?a on th~s,
Fy
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~ •'hP - - -foy of ~ s+. ~ g Z.: - -
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~ ~~Gr~n7~;pE - _ iITIE ~ N R
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~ - ~_~s_~.<:::~.~.*_ ~_~bc."~I~e~1 - - - `:`~i«~ _~ec;ai ~r~4ecLr~
~ :!:':'f •'_Mt:~:cc:fo ,,f v~:.. ~ tr,r,laJ b~ ':rw ta res~e ;~tknoN~dfyrorrJS nd'e:sent.o{ to fhe v~hddy of Not~:e of f~.ieiot 1~~ l~en G C M
l~<19, C P. i4i~i SI, i% ~
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~ PART 3-To tH va~d for r~cordi~ purpos~s
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