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F«m 46~ oe?~,~+vr oF n~ r~wsuer-r+r~e~uu ~v~ee~ s~nnce Fo. qo~~o~d u,~ er r«wd~
~ ~~tv. r 7Q~ C~T~iCATE Of RBE~SE OF EEDQAt TAl( tlEN
piSTRICT SERULL NUMBER ~
: ~ 209 B192 Pl ~ N~ ~ 1
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; 6325(oy, ~=•rerne~ Reve~ue eode. hrn?e been wtisfied w~th res~ect a the rc~xes enu- ~
meroted below, MgetFbr with oll sMhrtory additions provided by Settion 6321; ~d ~ ~
t??a? e~e i~~fo. such raxes and sroluron? edd'i1io+~s has Nierebyr bean reieosed. T?: i~~~V`~`O
' o4Fir.er in tlie ofrico where ~w~ic4 of intarnol rrvenue tax lien was ffileeci o~
Pro
1? .
; y , 14_Ll . is har~eby outh~xized to ~iake ratation
on his boohs b staw the rdease of soid lien, insofar as the :ien relates to the fullow• -
' ing fazeS.
MMAE OF UXPrhYER
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' ~ ~ Y f~ -
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RESIDENCE .
~ ~ ~
UNPAID BALANCE
~ KIND OF TAX TAX PERIOQ ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSMENT
Ial Nl kl ldl Iel
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~ ~M Z..w. 3i.1~•~a sW N~M sl~.~i~1
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~ : PLACE OF HUNG
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~ TOTAI s ~1j~~
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~ wITNESS my hand ar Jacksonvil2e, Fl~rZda _ , or: ~.~s,
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~ +t,e lu + n ~r of J ~ne , 19 71 - - ~
~
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~ S~GNIITL"~tE ~ T1TlE
~ ~
~ ~ L~vis ' F• r ~
.,2.r~ Chie.~ ~~er,ial Pro~-edu~e s :'>~aff
(NOTE Certd~cote of off ovr ~zed br law tn s,,ae ocknowtr~grn~{t~ ,s ~o± e,sent~:~? ~-~ne vohd•ty of Nohce of iecie.ol Toa t~en G_C AA_
~ ~64i9 T?5.)
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~ ~ PART 3-To b~ usad ior ~ordino gurovses
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