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fOrtn 668 DfPARTMENT Of TME TRFASURV-NtER.VM lErNUE SENKf For Opfionol Uf! RKOr ^y Ofl~ite
~~tir ~-~o~ cOtTff1UTE Of RELEASE OF FEDdtAI TAX UEN o 1?Ma A~~;p~~
DISTRICT SERIAL NUMBER ~~~06ER F91TtA~~
709 V 9w P w98 aIERK :~~1~ S~ ~
I hereby cefify that as to the following-named toxpaYcr the requirements of Seclion Rft9R~ YER~F~EO~
6325(oj, tnternol Revenue Code, have bce~ satisfied with respect to the taxes enu- ~~j ~
` meroted below, together with oll stotutory odditions provided by Secfion 6321; c~?d
thot the lien for such taxes and stotvtory odditians has the~eby been releosed. The
proper officer in the of£ice where not+ce of internal reveoue tax lien wos filed on
,~i].. 4~ , 19__?1_, is hereby authorized to roalce nototion
on his books to show the release of said lien, insofor os the lien relates to the follow- A~ O~
ing toxes. ~`.'L
NAME OF TAXPAYER ~
RESIDENCE ~ j~
~ ~lMI ~~•j~
! ' UNPAID BAUNCE
` KIND OF TAX TAX PERI00 ENDED ASSESSNIENT DATE IDENTIFYING NUMBER OF ~?SSESSMENT
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~ 91~1 03-~-71 i•Zt~A 31!'-~'i~?
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r''-, PLACE OF FIIING C~1t,
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WIiNESS my hond at
the _~t~doy of IIa ost,.r , 19
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i~?5 SIGNATURE i1TLE
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'~'j (NOTE: Certificote of u by low to to ocknowiedgmenh is nd essent~d to the vdidAy of tJotice of Federd Tax licn G.C.M.
?6419, C.B. 1950- . 125.) dd
Y4' PART 3-To b~ vs~d for ncordin~ purpos~s
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