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---~orm 66S OE?A2tr~ENT OF iME TRfASURr-NIEQNAI REvENl1E S~VICE • for Opt~o++o! Ux sr Recwd~g Olfice
(REV. 1•7D1 CERTWUTE Of REtEAfE Oi ~EDBGL TAX iIEN ~tL[D AMD fIEC
=T. ~11C1E C0111lTY
~lSTRtGT SERiAI NUMBER IIOCE~t POITNAS ~
' ~w~~a • ~ ~ p CtERr C~~CYIt C01MT t
1 he~ebr certify tha? as to the following-named taxpoyer the requirements of Section ECOBO VERIf1ED~
6325(a), Internai Revenue Code, have been satisfied wifh ~espect to the taxes enu- ~y ~q
; rneroted below, together wi~F? all stotutory additions provided by Section 6321; ond e 3 9 v~ Iw1 IZ
that the lien fo? such taxes ond stabtory cdditions hos the~eby been ~eleosed. The
proper ofFcer in th~ off~ice where notice af internol revenue tax lien was 61ed on
OcLobeT 2S, , 19 ~i , is hereby authorized to rrioke notvtion
on his books to ~iww the release of said lien, insofa~ as the lien relotes to the follow-
ing taxes.
NAME OF Ti~XPAYER ~s~ ~i .
RESIDENCE ~ ~ ~ ~
~M~~
i
i UNPAID BAUNCE
i KIND OF TAX TAX PERIOD ENDED ASSESSAAENT DATE IDEHTIFYlNG NUMBHt OF ~,SSE~I~AENT
~ I~) l~) kf (d) la)
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~ loyo 1t~.~) 3-~-?0 ~"1~-~.~ii3 i~T•q
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y0iro i!-j3~i 3-lo-7r t~'f~-~-~
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~ 3-06-?~ 3.~
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~ PIACE OF FItING CS~~. Q~is _
O~~ TOTAL S s,~~ ~
Ao~~M~ n+a.
WITNESS my hond ot T~~kArrnri 1 l~ Flnri~ . on th~s,
N:
rhe ~st dar of ~1Bb2'uaY'y 19 72
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'r~ SIGNATI~tE T1TLE
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Jack Dur ChieY, 9pecial Prxe~urea Staff
'p:,>,
(NOTE: cote Ker outlariued by to take ocknowld~rneoK K not esscntiol b 1hs vol+diy d No~ics of Fed~d Tox tie~ G.CJN.
- 26I1 , C.B. -Sl, 1~5.)
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~y PART 3-To b~ vs~d for ncordin~ purposes
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