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Fonn 6~N ~ U. 5. TREASURY DEPARTMENT - ~NfEr+N~~ rtFveHUE SEav~CE Fo. qp.o.~i UsM° ~ '+t ' N c• ~
tRfv. s.s~r CERTIFICATE Of RELEASE OF FEDERRL TAX LIEN ~~Mt~ . •
DISTRICT SERIAI NO. ~
1 ~'l~l3+~ 188504 B182 P966 ~E~ ~
t~ER~ C=~CWI LOIMT ~
I hereby c~rtifr tF?ot as to the Following-nom~d toxpoye~ ths requ'uem~nts o( Section 1t~C~D YE~+F~E9.~¦~.~~i
6345(a), Internol Revenus Code, hove been sotisFied w~tl. respect to the toxes enu- ~~Q
m~roted ~lew, together with oll stotutwy odditions provided br Sectio~ 6321; and n
thot ths lien for such taxes and stotutory additians hos ther~by been ~el.os•d. The
prop~r o~fic~r in the of(ice where notics of internol revenw tax lien wos (iled on
.~J~l1dT~L 19 ~ , 19 7Q" is hereby outF~wized to moke nototion
on his books to show tfie relsase oF said lien, i~soFar os the lien rtlores to the Ij~,~NyQQ
following tox~s. ~rlfi~j~0~7
NAME OF TAXPAYER
s~r x. a~ ~ c~?~r
RESIDENCE
j~,~l SAs ~all n!~l~~ ~r~ r~~~M~ ~t~•3~
; CLASS OF TAX UNPAID BALANCE
f (Toz R~turn Fwm No.) PERIOD ENUED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~ ~a ) ~b ) (c ) ~d ) (e )
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; l~o~lr~ ~2-31-66 ~-~9~69 ~8~6Z
; . id~ 1z-33,.bT d-t9-69 2t.i~
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PLACE OF FIIING a11~it QA!'~
.~'i~ L110~ QO~~ T OT A L S~s~
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~NITNESS my hond ot Ta kconvil le ~'lorida , on this,
the~_doy of ~rp~r ,19
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SIGNATURE TITLE
~y
S e ia Procedures Staff
- (NOTE: C~rtificote o( oificer or e by law to roke ackno» yenems is not e+senf~ol +o the ~otidiry oi No~~c. o; F•de.ol To,~ Lien G.~JiA.
2r,419. C.B. 195P51. 125.) 33
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r~~ PART ~To be used for recording purposes
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