HomeMy WebLinkAbout2940 h~ ~e U. ~ TRFAS!iRY OEPARTAAEM - WTERNAI [fVENUE SERViCE ' f+r QMIaMI p~ OMle~
;~ev. ~ ~€RTlflf~TE Q~ ~ ~EDERAL TAX LIEN
DISTRICT SfRt/LL NUMBER
~ 171483 H174 P200
1 her~py cert~fy thot es to tM follow;np-twm~d to+cpaysr Nx •equ~rements of Sr_tion 63?Sl~i.
I~rernal Rsvenue Code, hove bse~ sotisfied w~th nspsct to the ta:cs envme.ared befow. toge~her ANC RE{',~~t~.
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w~th oll statveory odditions provid~d by Ssction 0321; ond thot !he I~en for wch te,ces ond ROGEn P~~TRA: ~V
statutory odd~e~ons hos the'sby bMn nieased. Tiw prop~~ off~cer in the office whs~e not~ce oi ~',~ERK Cic:~U1T C~VAT
in+~rrfal rw~nve rox 1'~ wos filed o~t ~Cf.O~@I` , 14 ~ , is hereby REC~~t~ Vf ~ IF:E(1
outhorix~d to moke notonon on his books to ihow 1he ralewse of said 6er~, insofar as the I~en
relotes to tM folbwinp taxes. ~
NAME OF TAXPAYER
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~SS OF TAX l~1PA1D MWJCE
~ (Ta~c Rdvm Form No.~ PERIOD ENDED ASSBSMB~lf DA?E 1DEMIFYING NUMBfR OF AS~BSAIIBiT
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- ~ TOTAL j
Tt. n~alr.~ t3+~sl+i ~
- WITNESS my hand at_ .Iacksanvills~ F1~R'1ds , on this,
the day of~L~llal`y , 19~ ~
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- SIGNATUR TITLE
f e rea S f
~\^3 (NOT . enlf~c~te of offiar outhorized by low to take ocknowtrlgmenls is not essentiol to rhe va''d•!y of th~s docurncM. G.C.M. ?6119, C.B.
_ 1950-1. 125.) aa
PART 3-To b~ used for rocording purposes
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