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' Form bbd t U. 5 TREASURY OEPARTMENT - u+TER~I+~ REw~NU[ SERVtCE Oa. aal ~he B~ R«wd~wq QN•ce ~ .
; rRev. a-E~~ tER11FICATE Of REIEASE OF F~AI TAX l1EN
. DISTRIC7 , SERIAL NO. • • ^ ~T.111C1E COHNTY~IA. • ~
; ~ 2 IIOCER POITItAS
i C~Ea~ Ci~cuit COUR
, 1 hereby c~~tify thot os to the follow~ng-oom~d toxpoye? the requirements of Sectioo ItECORO YERiFtEO
, 6325(01, internol Reven~e Code, hove been sotis(~~d witl~ respece to the to:es enu-
~ merottd b~lc~, togethar with oli stotutwy odditions provided by S~ction 6321; and ~ Ac ~~ZI
j tho~ the lie~ Io~ sucl. eoaes ond stotutwy odditia~s hos thersby bee~ ~~leos~d. The w
' propsr olficer i~ h office «hers ~otice o~nterewl revenw tox litn wos filed on
zTanuary , 19 7~ is heresy outhori:~d to mokt ~ototion
~
on his books to show the releose of soid lie~, insoFor os th~ lito rebtes to the
' followinq toxes.
, NAME OF TAXPAYER
0~~ ~
,
. RESIDENCE ~
~ ~ ~ M~ ~/!Ma -
~
, CIASS OF TAX ' UNNAID BALANCE
{;o: Retu~n Form No.) PERIOD ENDED ASSESSMENT OATE IDEN~IFYING NUMBER OF ASSESSMENT
~ (01 ~b~ (c ) (d 1 (e1
~~V 101~0 1~~~'~6T : ~~1t
~ ~ ~~7~°'~~~~
PtACE OF FiItNG
_ ~ ~ ~ TOTAL S
~ ~ti~ HAl~~ ~L•
A
wiTNESS my hand ot Jacksonville, Florida , un th~s,
the 22nd doy of J:uie , i9?l
51GNATURE TITLE
+ ^ ^ D }g,£ f
(N~TE: CeniFicot~ of ofl~cer 'aed low tnroke ot4newl~dq~nent: is not esse.+~~o to tM ~ol~d~.y ei Na~c• d F•derol Ta, L~~n G.=~1A.
26r19. C.B. 195P51, 12S_1
~ R ~1~
g~~~~~ PART 3-To be us~d for recording purposes S'