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FQrm tibE DfF~~r.~F!iT OF Tj-!E TQf~SURr-1NTE?N~. iEVENUE SERVlCE Fo~ ~~~.,.,07 Us.• Br Recar.~..,g 171~.ce _
~a~v. CERTIHCATE Of REIEASE OF FEDERAL TAX LtEN
DiSTRiGT SERIAL NUMBER C R j
J~w~~s 17575 - R~~AO E~I~i~~
1 hereby certify that cs to the fofiow~r?g-named toxpoye~ the requirements of $ection
6325{a}, Internol Revenue Code, have been satisfied with respect to the taxes enu-
merated below, togethar with a!i stui~tory additions provideci by Section 632 i; and
that the lien for such toxes and statutcry additions has ther;:by been reteased. The
proper officer in the o~ice where notice of internal revenue ~ax I~en was filed on
_QC..~pber 20 19~1" is hereby authorized to r?take notation ly~q~la1~
on his books to show the releose of w~d lien, insofor as the lien relotes to the follow-
ing toxes.
NAME OF TAXPAYER ~ ~
RESIDENCE d ~ss~M~
i n~l~o.~ ~'l~sa.-33~i~~
~ ~
UNPAID BAIANCE
j KIND OF TAX TAX PERI00 ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
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_ PLACE OF FIIING (~,i~it O~i
~ ~ ~ C~~~I TOTAL S ~f
tL. n~lO~~ ~3t•
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wITNESS my hand at Jacksonville Florida , o~ th~s,
5
the 16th ~y of Merch , ~9 72
~ ° SIGNATU - _ TITIE
ran Chief,Special Procedures Staff
' NOTE: Ceit~ficote of officer author~zed by law to 1aKe «knowiedgmen?s n not essentiol ta the valid~ty of Notice of Federol Tm litn G.C.M
= 26419, C.B. 1950-51, 125.)
PART 3-To bs used for record'+ s~s K r.+V V P.~f~~
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