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FOfT bGH AEPARTMENT OF TfE TlEASUlY--~IjEiN/LL lEVENiIE SERVICE For Optiona! Uf! M Retord~ng OI6cY
~~v. i-~o} ~CERTEICATE Of lEIE~SE OF iEDER~I TAX L~N ~pG v
715TRICT SERIAL NUMBER ~~piY A6
~ 2ob868 $i91 P9b3 ct~~t ~eVRT ~
I certif that as to the followi nort+ed to er the requirements of Section M~~~ ~_~i~i~0~
herebY Y ^S' ~Y
6325(a), Internol Revenue Code, have been satisf'ied with respect to the taxes enu- f
merated below, togeM~er with all statutory odditions provided by Section 6321; ond a~~
that the lien for such toxes and statutory additions hos thereby been released. The
prope~ of~ice~ in the office where notice of intemo) revenue tax li~n was filed on
Ma!'Ch 30. , 14~_, is hereby authorized to rooke notation ~rj,;~~
on his books to :h~w the release of wid lien, insofar as the I;en relates to the foltow- ~~+r[
ing taxes.
~ NAME OF TAXPAYER
` t'ils'l1~1~ li~t~lt C~• -
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,
RESIDENCE
r. o, '.ac s~
- l~rt ~i~ras~ ~'La. iis60
~ ur~Pan sAUwcE
~ KIND OF TAX T'1X PERIOD ENDED ASSESSMENT DATE iD~NTIFYING NUMBHt OF ASSESSMENT
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= PLACE OF FIUNG
Cl~~ C~ni~~r C~ltr TOTAL S
at. Lt~si• C~t~r b, ~6t . s8
- ~ l+~rt H~rei. ~
mville F102'1~ , on this,
WITNESS my hand at ~j,a(~~C$ ~
!he day or J~1Lliu'Y 1 q 72
;IGNATURE T1TLE
Chiei, ~ecial procedurea Staff
~
(NOTE: ~ ~cate of cer autno~~z y iaw to roke ockmwiedgments ~s not rsent~o~ to the ~al,drty ot Not~ce of Federol Tax L~en G.C.M.
< 254 i 9, B. 19 . 125.~ Sa
- PART 3-To be used for recording purposes
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