HomeMy WebLinkAbout0629 F«m 66a oEr~x~r~Nr of n+e ~etwwn-t~rr~~ruu eEVE~vue s~R+nce Fo. op~aal t?,. er aoowdr++p oiFc.
teEV. ~-~o~ tERTiiUTE Of RHEAfE QF fEDERAI TAX LIEN = Au RE
DISTRIC~ SERIAL NUINBFR •
~ ~ A RECOitORKR ~ l
1 hereby certify that as to the foilow~ng-nomed ta~cpeyer the requirm~ents of Section .
6325(oj, Inta~nol Revenue Code, have bee~ satisfind with respect to the taxes eou- ~
meroted below, togetfie~ w~th oll stotutory odditior+s provideci by Section 6321; ar.d ~ ~ t~
tiwt the lien for sucr taxes und siatutory add;tions has thereby bee+~ released. The
ptoper officer +n the ofi~ice where notice of inte: nol revenue tax lien wos filed on
~+.eher 2~~ , 19~1, is ieereiny authorizerf to niake nolation
on his books to sho,nr the release of said lien, insofoe as the I~e+~ ?e~a?es to the follow-
' ing toxes. '
NAME OF TAXPAYER
~~~~~r ~
i RfSIDENCE ~ .
;
~ n. ~LM~~
~ - . UNPMO BAIANCE
~ KIND OF TAX T/U( PERIOD ENDE~ ASSESSMENT DATE IDENTIF1fING NUNIBER nF /~SSESSMENT
, lal ibl kl ~d1 ~e~
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~ s.jo-n ~-sa.~s s!-~t 9~f•N
~
Y
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:
4
£~r
~S
F'
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~
Y~$
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ij
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f3
_ PL/1CE OF FIUNG C~it
j~~ i OTAL = ~
hr+ ~s+~'OS~ ~i~
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VVITNESS my hand ct ~ ar L c n.. i g~~' l nr i-~ a - , on tfii3,
~~~J7 ~ ~
~he ' t~ dor of `;ove~i~ar , 19
F:~ StG- - TURE T1TlE
:~;i
ejs~. ^ ~ ~ r ~
: CertiFicale of ofF~cer au ~zed b~r law ro roke «k?wwledgmer?a is na esseN~d ?o ?he voGday of Na~ce o1 federd Tox lien G.t.M
_ 46•119, C.B. 1950-51, 125.)
ss
PART 3-To b~ us~d for ncwdi~p pu+pos~s