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< i ` U. S. TREASURY DEPARTME - INTERNAL REVEN4E SERVKE _ = F~r ON~oMI tlst qt R~cw~/'r~ 01/!c~
(REV. &6 , . ~ CERTI~KATE Of RELEASE Oi EEdERAI TAX ~LI~N = _ , ~ ~
~ISTRICT SERUL. NO. ` FOITRA~
1~~'180 B 176 P~'j6 ~fRK ~CU~T COWtt~
' 1 j+•r•br c.rt~lp thet os to tM followiny-nam~-toxpar~r th~ ~tq~irsnNOts of S~c~im RECORD Y(RlFtEO~~...j~
~ 6325(0), (et~rnol R~v~ew Cod~, hov~ bNn so)isfi~d with r~sp~ct to tM tox~s enu- ~ 31 pV ~~q
mnet~d ~low. to~tF~~~ wit6 0ll stotu~ay additioos p~ovided by S~ction 63Y1; aod ~ 17 (
that th~ lien for such tox~s ond stotutory cdditioos Fas tl~irebr b~~n rel~ostd. The
prop~r oiiic~r in of ic~M~ eoticep int~rnal r~venw tox li~n was til~d o0
, 1 ~ is M..by ov+h«i:.d ~o ~ok• norotion
on his books to show th~ r~l~ose of soid li~n, insofor os tb~ li~n r~bt~s to t!N ~jp~
j followiry tox~s. ~WfA
~ NAME OF TAXPAYER
I ~ J. • t~? l~~C~i~1M
I
~ ResioENCE ~a~i iNir ~a. ~~t
` . UNPAID BALANCE `
{ CU1SS OF TAX "
(Tnx R~turn Fwm No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~o) (b) (c 1 (d ~ (e~
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~ ~ ' 7~
5
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4
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1
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t PLACEsF FILING~~~S ~e
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~ TOTAL 5~~~
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WITNESS my hand ot Jao1[son~111e, l1Ca'1d8 , on this,.
Y
f
the ~ day of ~ ,19?2 `
SIGNATU TITL~E - ,
~iQ~ ~i t~ts .~1~C~81 plO~~S .~=t
,
MOT ~rtific o1 offie~r eutheri br low ~o tok~ oekne.rled9aMn~s is nor ~ss~Miol to tM ~oliditp ef NWie~ d f~dNal Ta: li~n G.CJiA. ~
. C.B. OS1. 125.) ~ ~ ~
PART ~To b~ us~d for r~cordin~ pu?pos~s '