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i 'FOff11 6GH DEPARiMENT OF ME iAEASUM-NTE~IAL lEVENUE SgY1CE For Opfionol tlst Br Recwdng CM'ict
(r~v. 1-70) CNtT~KATE OF REtFASE QF lEDBGI TAX UEN ~
. i~ Y ~
' DISTBICT SERUL NUMBER ER ~01T~A
~ ~ 217577 8196 Pi6~.t ~~~K c~Rcu~T carRT~~~ .
i I hereby cert~fy ri~a~ os ro N~e follow~ng-named roxpayer rhe requ~remenK of Sectioo RI~COR Y~RIFIEd.,...~~
6325(a). Internal Revenue Code, have baen sotisfied with ~espect ro the taxes a?w ? ~ :
merated below, together with oll staitWory oddfions provided by Sectia? 6321; ond i~~ ~
' that the lien for such taxes and stotutory addiiions has thereby been released. The ;
~ propcr o1i'icer in the ofF'ice where notice of internol revenue Mx lien was fikd on 4
} October 20~ , 19~1, a hereby avthorized to ~iake notation ~
on his books to show the release of said (ie~, insofar os the lien relates to the fotlow- g
. ing taxes. ~
~ NAME OF T/1XPAYER
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l~rL ~eaM ~Ia~~lr ;
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RESIDENCE ~ ~ T~1 ;
~'~i~ ~MI
UNPAID BALANCE
KIN~ OF TAX TAX PERI00 ENDED ASSESSMENT QATE IDENTIFYING NUMBER OF ASSESSMENT •
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~ ~ PLACE OF FiUNG
` Q1~aet, ~lsadt Qari -
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lL~e+N, l1s. ~
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~ Jacksanvills~ Florida , o~ rh~s,
- V1/ITNESS my hand ot
~e 1 t,h ~r of M~'Ch , 19 72
=;i ~ ~oo ~is~s
SlGNAT T1TlE
~ Ch3ef, ~ecial Proced~aes Staff
~4:
~NOTE: t~ficote of officer outhoraed bp law ro toke ocknowledgme~ts is not essentiol to Ihe voliddy of Notice of Federal Tmc lien G.C.M.
T , C.B. 1950-51, 125.)
ss
PART 3-To be used for rocordin~ purposes
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