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fcxm 656 ~PAR~n~'.M OF iTSE 7i~ASURY-l~t1FiMK RivFtiVE SE=YKE ~ for Opr~orwi Uae 8r Record+g OfF,ce
~~EV. ~%c~ CERTIRUTE Of REtfASE OP`FEDE~tRt TAX UEN
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II wi I rned to er the r uirements of Sect+on ~j,~ ~1~~ r ~
; her~y cert~fy that as to the fo o ng- xpoY e9 _ RROQIIO Y~RI?1 ~
6325i~), inter~al Revenue Cude, have been satisfied wdh respect to the taxes enu
merated be~ow, ioc~ether w~th afl statutory odditions provided by Section 63?1; and ~
thot ±he lien for such roxes ar.d statutory odditions has thereby been refeased. The rW ~
' prope~ ot~.cer in~jhe oftKe where notice,,,Qf interno) revenue tox lien wos filed on
_ den11ffi'~(~__ 19 rl , is hereby outhorized to rhoke notation
on h+s books to show the r~lsose of said lien, insofar as the lien relotes to the follow- 21~~p~ryt.
ing taxes. 7~7 / ~
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~ NAME OF TAXPAYER ~1~ ~ ~~s ~ ~i+~
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~ RESIDENCE a~~ ~
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tNIPA10 BAUNCE
~ KIND Of T/1X TAX PERIOD ENDEO ASSESSMENT OATE IDEMIFYING NUMBER OF ASSES'SMENT
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PLACE OF FlUNG
~ ~~~~i~ TOTAL S ~
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- WITNESS my hond at Jackamville, F10~'1d8 , on this,
st dor of Dece~ber , t9 ?41 ~t~~x19? PACE~~
~GNATURE a
~x J Dur~t Cbief cial ProOeduree if
E: Cert~fico~e of of~'Ka auttaraed by law to toke ocknowledgmenls is nd essennd ro the votidiy of Notice of federd Tax l~e~ G.C.M
26119, C.B. 1950-51, 125.)
PART 3-To b~ us~d Fw nco~din~ Pvrpos~s a a
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