HomeMy WebLinkAbout2069 FOrT ObH DEPARIMENT OF THE TREASURY-NITERNAI RSVENl/E SERVICE for Oplanol Use By Record~ng O(fice
~s~v' ~-~a~ CERT~iUTE Of RELEA3E OF ~EDERAI TAX UEN i.IUC~E COUMTtr~~, '
D~STRICT~~~w SE 2152~ B195 P1196 RECO~
RK~CIHCUITRCp=jIRT
I hereby cefify thot os to the foliowing-nomed taxpoyer the requirements of Section ~ ~EAIfiED~i~
6325(0), Intema) Revenue Code, have been satisfied with respect to the taxes erw- ~
merated below, together wilh all statutory additions provided by Secfion 6321; ond ~ ~~~1 ~t
thot the lien for such toxes and statutory addifions has thereby been released. The
proper ~p
rr~~~t
~ pjfice where noticep interno) revenue rox tien was filed on
~s , 19 r~, is hereby authorized to rt~oke notation
on his books to show the releose of wid lien, insofar os the lien relates to the follow- .
ing taxes.
~JMAE OF TAXPAYER 5~~~ -
icESIDENCE ~
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~ n~aa
UNPAID BAIANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DAiE IDENTIFYING NUMBER OF ASSESSMENT
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s 9k1 14-31-TO 6-k-?'1 S~9'-3tt~ 1~6~•7'k
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~ PLACE OF FILING ~1~ ~lt ~~i
~ TOTAI S ~ ~
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F°t. li~roe~
~ 'rV;TNES$ my hand at ~~C~cs~'lvflle~ r~'ida , on this,
+~E, 15th day of ,f ~C'Z ~ ~ 9 1 ~
_ ~iGNATURf~ TITLE
r ack ~urant ChieF, ~Qecial Frocedures St~ff
= TE Ce~bf;:~te of officer ov'hcrzed by ~aw to take acknow'edgments es nut e:sent~ol to th.e vofidity of Notice of Fedtiol Taz L~en G.C.M.
2b419, t.9. 1950-51, 125.)
" PART 3-To be used for reco~din u ses BG~K ~ P~G~~~~I~VJ
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