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Fora~ 668 o~urr?~?~rt oF n+E n~wA~er-a+~?t ~va~ sem+cE fo. C~~o~ot u,. sy t.oord.p o~o.
c~?. ~-~o~ ce~~u?r~ o~ ~ o~ ~euu Tuc u~ ~ '~!~~;E~~
DlSTRICT SERIAL NUMBER
223142 8199 P952 ~ ~k C
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; i hereby certify Ihat as b Ihe rtolbwi md taxpayer ths roquiremenis of Seciion 0 YER4itE0~
, 6325(a~-trNe~nat Revanue Gode, hove bean soksfisd wiih r~espsc.t ro the taoces ~nu- ,n t '
. m~nolsd belo~w, bgslher with oll stahrtory adddions provided by Section 6321: and W~~~~ :
; thot iha lien for wch taxes and statutory adfi~liau has il~xeby bsen neleo~d. The
pro~~x ofiioar in oliioe where~~,pf i~tiernal revenus tax lien wos fiied .on +~r~y
_ February ~ 1 q l L ~ it hasby oulhorized ro matce notdion 1~iA~r
on his books to slw~w ths relsose of soid lien, insofar as the lien relalss to th~ follow~ -
irg ta~oet. -
~ PJ/NAE OF T/1XPI~Y9t
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Mt li~~ R~S~ia ~IM
~ ut~NU a~ur~ce
K~ND OF UX UX PERIOD END~ ASSESSMENT DATE IDENTIFYING NUMBER OF /IS~AEM
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PIACE OF FlUNG
; TOTAL = ~
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E WITNESS mp hond at Jackaonville ~ Florida , on this,
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3 .
t the 13th day of April , 19 72
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~ SIGNATIJRE TITLE
~ Durant Chief S cial Procedurea Staff
3 NOTE: CertiAc ol~'icer authorized by low ro take «knowledgmenfs is not asentiot ro the vaGdily of Notice of fedard Tmc tien G.C.M.
. 50-Si, i25.) ,
PART 3--To b~ us~d for recor~n~ purpos~s lc
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