HomeMy WebLinkAbout2073 Fo•~n bbg U. S. TREASURY DEPARTIAEN7 • n+rea?+~~ r+e ~eNUt sEaviCE Fw Oor,a,wl Use By Recwd.~+q dl~ce
i;RE~. 3-67! CERTIFICATE OF REIEASE Oi fEDERAI TAX LIEN
DISTRICT = SERIAL NO. ~
h <<-t ~Sh893 B180 P21Q5 C~R~l ~
1 e eby ce ~ y thot os to the following-nam~d toxpoyer :he re uirements of $ect~o~ ~
6325(0), Internal Revenue Code, hove been sotisFied witF respect to the taxss enu- tE ~!ry~~~
'
merated belc«, together with ali stotutwy add~tions provided by Sectio~ 6321; and
thot the lie~~ for swh taxes ond stotutory odditians hos thereby been releosed. The
proper o(ficer i the o(Fice whers not~ce internol revenue tox lie~ wa: (iled on _
Oetober ~7, , ~9 g9" is hereby autho?~zed to moke notat~on
on his books to show the releose of soid lien, insofor os the lien relofes to the ,
' following toxes.
NAME OF TAXPAYER
~TNM k LO~M 1 • C~~'P'~'~
R£SIDENCE
, 1 ~ / sv
' l~orti Pi~ro~, ~'lorirds
~ CLASS OF TAX UNPAID BALANCE
i (Tax Return Form No.l PERIOD ENUED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~ l01 (b ) (c ) (d ) (e )
F ~0 12-33~67 5-3~-b8 ~62-zo-3~l~o i 153•99
; u~o ~2-31-65 5-23-69 ~6~-so-~o 88?.57
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- ~'LACE OF FIItNG C~~, C~~ ~e
_ s;~ ~ TOTAL S
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~ WITNESS my hand at Jack4onviLle;; 'rloria , on th~s,
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the~doy of 19 _
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SIGNATURE TITLE
,~j Jae ~hie f cial °roce dureF Staf f
_ ~N Ce. ~care oF o«icer au~horiied by law to take ocL.no»fedgments ~s not essenf~ol to the vol~d~ty of Not~ce of Federal Ta¦ L~en v.CJill.
' 151 , .B. 195?51, 125.~ -
ss
PART ~To be used for recording purposes _
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