HomeMy WebLinkAbout2842 po~m ~g i- U. S. TREASURY OEPARTt+tENT - ir+TFR~.~~ REvENUE :ERV~CE Fw r~ ' @~Rec d.qOf(~c•
:R~~ e-s~~ CERTIFICATE Oi REIEASE Oi ffDERAI 1AX IIEN f.~~lE cou t
DISTRICT SERIAL NO. RO~.ER ~
J . Fim~ie~ 192520 , 8~84 p491 c RR c~~c ~ .
RO YERIf1E0
1 6ereby certify tho~ as to the (ollowing•nam~d toxpoyer the reQuirsm~nts of Sec~io~ ~
6325(oI, Internol Revenue Code, hove been sotisfi~d w~th ~espect ~o t!~e toxes cnu- lD
meroted belc+v, to9ether with ali stotutoir additio~s prov;ded by Ssctio~ 6321; ond ~
thot the lien fo~ sucF~ taxes a~d statutorr odditians Fws thcreby been relecsed. The
p~oper o~ff
~yer r~ the olfics where notic•~ /o~f inter~ol revenue tax lien wos filed on
~i'~..i ~Ls , 19~~! , is hereby authorized to moke nototion
on his books to show the ~eleoss ol said litn, insoFor oz the li~~ retotes to tM
(ollowiny toxts.
~ NAME 4F TAXPAYER
CLARKt~1CE N• d~ ~'.t~?it HlIY.ffi.t.IB~ ~
~ `
;
F RESIDENCE
' ti~?t~ 1, Eaoc 8Tl,, Pbrti Pis~, ~L.-33~54
~
3
~ CLASS OF TAX UNPAID BALANCE
~ (Tax.Return Form No.1 PERIQD ENDED ASSESSMENT DATE ID'c~tTIFY1NG NUMBER OF ASS=SSMENT
~ (a) (b1 (c) !dl le)
~
~
4
s
:a
3
10li0 12•31-5$ b~3-TO 2~r?3~-OC~rb
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= PLACE OF FILING CZAl't~ Circuit C~trt
Str~ LLtC~ COjID~~ TOTAL S gt~~
~ Ft.• ~`I'Ce ~ F~i • ~
- WITNESS my hond ot Jackaox~vills, F10T1da on this,.
the ~2l d~ 4f DBCea?be!' 19 71
.
SIGNAT TITLE
`~4 CiC
_ ~
~ AlY' 8At
(NOTE: Grtif;coN of o(fic~r eurhori:ed by low ~o roke ack~owledymems is no? essen~~o ~o rh~ .al~ditr o Not~c• Fe tro oa L~ ~r G.CJiA.
- s6.~9. C.B. 195051. ~~s.~
~ PART ~To be used for recording purposes a~
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