HomeMy WebLinkAbout0973 • o~eu[r~rir oF 1?~ n~~un-~,T~ ~v~r~E sE~v+ce Fo. op~ond u,. sy lteoo.d~g ol~s
for~ 368
(RE_V. 1-70) ~~~A~ ~ T~ ~
~is~wcT ~AC~011l~ii, ~ 2]~7~942 ~Bi95 p75? ' e r c
i I hnreby ce~tify fhat os ro the fdbwing-named taxpayer the requiremenls of Section K IqC
; 6325(0~, lnternol (tevenue Code, have beer~ aatisfied with respect ro the taxes e~w- ~ Q Y AI/1~~.,~
merated below, together with all statutory oddifions provided by Seciioo 6321; and
Mwt ihe lien for wch taxes ond srotutory additions .has tF~eby bee~ released. The
t proper ofF'icer in the Ql~ice where notice mternol revenue tax lien was Bled on
. 9aptember 1~ , 19~. a her~eby authorized to iriake r~otation
on his books ro show the releose of wid tien, irisofar as the lien relates ro the follow-
ing taxes. - -
NAME OF TAXPAYER ~S ~
~ jsM ~M ~!'~~M
~ RESIDENCE 1~ ~!r L~1
T'~ l~1~li~3~
UNPAiD BI?IANCE
~ K1ND OF UX UX PERIOD ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSMEM ~
tal (bl k1 tdl tel ~
i ~ ~ ~-~-~e ~•~o-n s.o~or.~
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C: ~
~ PLACE OF FlUNG ~S
x
~ ~ j~ TOTAL S
~ ~ M~'!~!~ ni~
;
WITNES$ my hand ot Jacksonvill.e. F10R'~J38 , on this,
::9
60t1K ~ PACE
~ the_~day of Maz'Ch , ~q72
-
:a SIGNATUR - TITLE
(r!O . ertificote of officer outhorized by law to toke ocknowiedgmenh n not ~sero~o! ro the volid~ty of Notice of Federol Tox Lien G.C.M.
~ 19, C.B. 1950-S1, 125.)
~ 98
~ PART 3-To b~ us~d fw r~cordin~ purposes
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