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~ ~ . ~ • - - • . _ . . ~ . . ~ a. - _ . . _ . . . . . ~ , a r. ~v~;c-m >Ya7~1S~cp~r:aa..u~A.. ~ . . ' -~.w~~, . ~ _ ~ • l . ' I ~ , . I Fo~ln ~ aF iRE/WJl1?-MFtiAI RFVENI~ SERVlCE io? Opfioiwl UM ti~KO?dNy OR~ic~ ~ ~~v iao~ CHTIRCAiE Qf RBEASE 01 t~OQAI TAX t~l ; ~~srwCr L~ = s~u Nt~se~ _ ' ~ ~ 2o Bzs 1~ e~wr , hereb~? oatify Nwt as to Ma folbwing~oomd laxporer the rquinma~ts of Section . ' 6325~a), t~ool Itwenw Code, have b~sn ~ailisfisd vrith respect to ths taxas e~u- ~ m~mted bslaw, iogslt~ with a!1 ~ory odd'if~'oas Exovidsd b~r Section 6321; a~d ~ i thot ih~ lien for such taxes and statuiory od~dio~ hos fl~eb~? b~an nleosad. ~e propK ollioK i ~oiRte wF~xe notit! ~eisrrwt reven~re tax lis~ was fdd q~ ' ~:_s~ant~a~~ZS. , i9~. is her~by ouH~orized to ~oke nototion • . on his books to show th~ release of soid lien. i~ofar as N~e lien ~ b ths folbw= i ~^p bxes: • . i NMAE .OF UXP~?YHt ~ ~ ~ ~ ~ ~ . i - ! RESIDENCE r~- ~ ~ . . ~ ~'r t~!'s~~~ ~ UNPAID BALANCE 'i I Klt~ OF UX UX PERI00 ENDE~ ASSESS~f~AENT DATE IDBdT1FY1NG NUM69t OF /~~ESSAAENT i la1 1b1 IdI ~ (e) ~ , ~I f i ~ ~ ~ ~ ~ ! ~ i PtACE OF FlUNG O~1wLf O~~ ' x. ~ ~ ji~L1 O~` TOTAL = ~ ~ M~l~M~ ~i~ ~ WITNESS mr hand ot Tarlcannv-ill ~ F`~ nrS da , on 1his, • ~ • ~ tfie _2.1:.~_ day of ~A ~.+.c~ T~?~e r, 19~ ~ S~GNA E T1TLE ~ Ciiiof : cial :'rocedure s Sta~'f ~ : Certificale oF of6cer outhwized by low ro tak~ ocknowledgmenb is no1 aseMid 1o th~ vdidilr of Nwiu of F~dard Tax litn G.C.M. 19, C.B. 1950-Si, 125.) gg ~ART 3-To b~ us~d for ncordi~q pu~pos~s - ? .