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FaX111 SS~ OfN1Q1A!ENT Of 1~£ TiLa$I,RY-RJ~EF~A1 RFYtNtiE SERYKE ~ f0/ Op~~vl Uf! Sy RKOrJ~ng O~FK!
t~rEV f.~ot ~ CERTWC~TE Of RElEASE Of FtDElUI TAX tIEN ~~qp~
D'S;RICT ~SERIAL NUMBER WCIE COIINTYRf~~
2i~303v Bl`~? :'1~~9 ROCER POITRA: ~
1 hereb ~ert~f that os to the follow: narned tax er the r_ uiremenh of $ecfion CIERK CIRCUII C011~T ~
r - r ^9- ~r ~ RECORO vERIf~EO~.,...~
6325(al, Internal Qevan~e Code, have been sotisfied with ~espect to the toxes enu-
rttero!ed below, togather w,th oll stntutory odditions provided by Section 6321; ond ~'Q Q 19
thot the tien for such toxes and statvtory addifions has thereby been :eieased. The J
proper officer in the of~ice where nohce of internol revenue tox lien was fled on
`_~g.r:~ar~~~_ 19~_, is hereby authurized to niake nototion
on his books ?o show t'~e reteose of wid lien, inwfor as fhe lien relates to Ihe follow- ~4~~
~ng taxes.
NAME OF TAXPAYER -
~!a ~ ~~ir
e~s~~NCE 661 s. s. ~Z.... ~ri..
~et ~aiiw~ ud~. T1~elaa 7~4~0
tR~IPAID BAUNCE
K1ND OF TAX UX PERIO~ ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSAAENT
(al (bl k1 Idl k1
lOMO lt-p~-d9 05-~7'0 ~~-!!lo ~.5~.~
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~ WITNESS my hond ot ~'•n 1 ~ n -'1 nr; ~:a on thes,
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{NOT . CertA'~cot~ ~f oif~cr. ovrt~~~ed by tow to toke ocknowled;~menh n no1 esseMrol to 1M vol,d~ty of Ne~~co ot federol Sa~ l~e G-C.M
~ ?W19, C.B. 1950-St, 175.~
_ PART 3-To b~ us~d fo~ ncordi~p purpos~s