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Fer~ ~ U. S. TREASI)RY DEP~1tTMENT - ~NrEaH~~ aEVEMUE SERwCE Fo. Ornonei Us~ By R«orl.M OH~ce
(REV. &6)) = CERTIiICATE O~ RELEASf ~ fEDERAI TAx t1EN ~
DiSTRICT SERtAL NO.
200591 B-188 P-233 M+~~1.I~r
1 hereby urti y thct os to the (ollowiny=ramRd to+cporer ths reauGem~nts o( Ssction
6325(0), Internol Rev~nut Cods, hove ba~~ safisfied with ~~spect to the tox~s enu-
msroted b~ic«, toyether with oll statutar odditions p~ovid~d by Section 6321; and f! ~EO ANO RECORQE•~
that the lien for such toxes and stotutwr additions hos thirsbr betn rtlcosed. Ths =1•LVCIE ~QIINTY FLA.
aoc~~ ~o~TR~a
p~op~~ ~ce~rj th~p~ice wher~ notice 9bint~rnol ~evenue toa lien was (~I~d o~ OIERK Ct :~UIT C4URT L~
t , 19~ is hereby outhori:ed to mak~ nototion RECORQ YFRlFIED..~...~
on bis books to show the relsose o( said lien, insofor os the li~n relotes to the
followinq toxes. to " 57 ~ ~~Z
NAME OF TAXPAYER
~ a ~ • oar?ss 222412
RESIOENCE
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j CLASS OF TAX UNPAID BALANCE
j (Toz Retur~ Form No.) PERIOD ENDEO ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
j (01 (b) (c ) (d ) !a )
i
1~0 1Z••~'~~-69 4~•,1S-?~0 ~t.~.y0
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- PLACE OF FIIING
CL~ CD~I~ COliitt TOZAL S~~~yp
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WITNESS my hand ct J~cksonville, Flo~'ida , on this,
the 18th doy of January ,19 72
SIGNATUR TIT~E
- ac raat Chiaf S ci~l Proc~durss Staff
( : C~r~ificof~ o~ oific~r a~~hori:ed by law ~o toke ocknowled9m~nts is not ess~ntiol to rh~ volidity oF Noric~ or F~d~rol Ta: L~en G.C.M.
264t9, C.BA~a~I~
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_ PART ~To be used for r~conling purposes
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