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foim b58 G:PAR7ytfNT OF 1NE TtEASUIfY-NTifL~Al RfVENUE SERY7CE for (:ptnrwl Use By Recordng CCnce
teEV. :~;~1 CQtT~1UTE OF REIEASf OF FE,lERAt TAX UEN ~~~EO akn ~ECVRUFo
DiSTR1 SERIAI NUMBER • Er. E~~C GOUNTY F`~(,
_~~1~~ ?~7~ ~I'~1 ~ 1'' CIERk C RCU T COURT
~ i nereby ce~t~fy that Qs to the fottowing-~~med taxpoye~ the reqviremenh of Secrio~ REtORD YEF~IFlEp~
; 6325(aj, internal Revenue Code, hove been satisfied with respect to tFie toxes enu-
' meroted be~ow, together with oll stat~tory o~difions provided by Secfion 6321; and ~T 1 ~ pH
~ that !he tien fcr such taxes and statutory odditions hos thereby been reteased. The
S pteperr o~-er i~ the of~'ite whefe notice of inter~a) revenue tox lien was filed on
> r?Y'~~ 2~.___. , 192~, is hereby outhorized to make notatio~
on h~s books to show the releose of said lien, insofar as the lien relotes to the fotlow-
_ ing taxes. ~
; NMAE OF TAXPAYER i C~QL 1• ~~ij~
~
~ ~ESiOENCE r~ O• DGZ Z~Y~
~ ~rlt ti~lM ~ ~l~riii~~3~1'~
" UNPAID BAIMKE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT OATE IDEt~RIF1fING NUMBER OF ASSESSMENT
~ la) (bl kl idl le)
~
lo~0 12-3~-69 1~.OiM.Ta ~7-~a-TSi1~ 1.355• ~'9
~
=y
'4
' PUCf OF flltNG
- Cl+~slt~ Cis~satt C~i
_3 St. L~si~ C~wt~ Toz~u f 1.3~5•?~
Tt. M~s~~, llt.
- WITTIESS my hond ot ~~C s~'~~' ~ = 1~;_ , on th~s, I
~ the + : i day of : , 19_'1
~
= SIG E T1TlE ~
_ ..K ~'.12'3T:} 'r= ~r~ _,-~A_,.; ~i ''rQ^BG~{iY'6S ~~.ra
(NOTF: Cat~6cote of o~cer outho.~ied by taw to to+~e ocknoarledgmenK n nd asrn?~of ro the rol~d~ty of Nohce of Federd Tox t~en G.C.l1~l
46st9, C.8_ 1950-51, 1?S.l
.S
" PART 3-7o be us~d ~ r~cordi~rp purpos~s .