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' .f OEPARTYENT OF TFiE T,REASURY - INTERNAL REVEtlUE SERVICE ~
FORM 79L I
(REV. SEPT. s.~ . UNITED STATES CERTIFICATE RELEASING ESTATE TAX LIEN ~
ESTATE OF RESIDENCE AT TIME OF DEATH ~
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~w?~o ~a~ ~oo s. s~.a. 226945 ~
DATE OF DEATM ~ sMC~~ ~1Ki~
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TO - Na~~ and oddnss of opplicaet(S1to~v Nw~6er. Sheet. Citr or Tow~. St~te. Z!P Code) ~
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: lrit~ 400
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I certify that the estate t~ for the above-named estate has been fully peid or otherarise pcovided foc. T6is cedi-
ficate releases t6e lien of the United States impo~ed by sectioa 6324 of the Intecnal Revenue Code on the pcoperty
described below: ~
~ Lst~ 4, 17, 1~. ~loak 521. rsst
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~t. Lrci~ ~a~ia~ 10. a 9~ivi~iN~
aoaaeiio~ to eM llat sb~srot a~ r~s~ci~d
is ?lat ~ook 12. !aM ~9, at t1N P~11ie
1~coria o! St. Leis Ooest~, Plotida.
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DISTRICT OR OFFICE -
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SIGNATURE TITIE DATE
~ ~ ~t 0it~etoe ' 11-15-71
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A'a ~~I~F~~'~I1~ J1'• . C~O ~{5.!!1 FORM ~2 (REV. 9-5S1
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