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Fo~m bbs • U. S. TREASURV UEPARTMENT - ~aTErtti~~'REvENUE SERwCE f Fo. q>r.awl (/se e~ R««d Oll~ce ~
;Rev. a5~1 CERTIFICATE Oi lEIEASE OF FEbERAI TAX IiEN ~ ' '
DISTRIC7 ~ SERIAI NO. J------------ - a~.~QC~ P ~S
,~l~es3~ 188656 8182 Pll CIERk CiACitIT tM ~
II w~n -nom to: o~r the re uuem~nts of Sect~on ~E~~ VERIFI~O~
f hereby certify thot as to the lo o g ~d p y V -
6325(0), Interrtoi Revenue Code, hove be~n sotis~ied w~th respect to the taxss enu- 10
m~roted b~lc+~, together with oli stotutorr odditions prov~ded by Section 6321; end V
thot the lien [w such toxes ond stotutwy oddifians hos thereby been relecstd. The
proper officer in the office wher~ notice of internal revenue tox lien was f:led on
JarilAl'V 21~_, 19~¦(..,. 7s hereby autF~ori:ed to inake notot~on
on fiis books to show the relaose o1 soid lien, insofcr os the lien ~elotes to the
followir?9 to:~s.
NAME OF TAXPAYER
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RESIDENCE
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CLASS OF TAX UNPAID BALANCE
(Tax Return Form No.) PERIOD ENDED ASSESSMEN7 DATE IDENTIFYING NUMBER Of ASS =55MENT
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PLACE OF FIUNG ;
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~ ~ TOTAL i ~~~n =
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WITNESS my hand at ~ack~mvii~ ~nri d~_ on this,
"~;t the ~ doy of ~CembeZ' ,19 71
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SIGNATURE TITIE
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J8C BYlti
(NOTE: Grti(icofe oF office~ ou~hori:ed by low to toke ocknowladq~~nts is not essent;o ro the volid~ty of NWice d Federo oa L~:r G.CJA. ~
' 26~19, C.B. 195051, 125.) ~
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= PART ~To be used for recording purposes