HomeMy WebLinkAbout0611 _ - - •1l~,~„4t--~---•~ •s-:--""""r"'":,_ _ . _ . _ _ - - - - -
• ~ U. S. TREASURY OEPARTMENT - INTERNAL REVENUE SERVKE Far OM~and U~t Br R~card~ny ONic~
(REV. aen ~fRTIFItATE Of tELEASE OF FEpER~I TAX_iIEN .
~ISTRICT SERIAL t~0. ~ pQ~.pQ~
~ 203645 8189 P2172 Et.~RK C~CtNt COW1~ ~
1 hsr•br e.nif~r ~Iw~ os to ~I~. toltow~ny-no~n.r ~oxPer.r ~h...q~K•~n.nrs of S.ct~en ~ECORD 1IElt{t1Ee~.~
63~5(a), Ip+~rnol R~venw Cod~, iwv~ b~~n safisfi~d with r~sp~et to ~e rox~s ~nu-
m~rond ~low, to~thtr with all stotutay adritioes povid~d by S~ction 63~1.; and .
thot tb~ li~n for s~ch tox~s ond stotutory oddltieos hes thir~br b~~n r~bos~d. T!w
prop~r oifle~r in tM offie~ wh~r~ notic~ oi int~mal~ r~v~nw tox li~n wos Fil~d oe
Jan~Y22~ ; 1~
71",i~ I+~r~br outhoris~d to nak~ nototim~
on his books to show th~ nlsos~ of soid liin, insefa~ os tM li~n nlatt• to thi
followi~ Mx~s. V . . . ~
~ NAME OF TA~PAYER ~
I ~ ~s .
i _
` RESIDENCE -
i ~ ~
~
; CLASS OF TAX UNPAID BALANCE
i (Tax f~etwn Form No.) PERIOD ENDED ASSESSMENT ~ATE IDENTIFYING NUMBER OF ASSESSMENT
` (o) ~b) (c) (d)
' ~
i ~-~i a-~ai ~ ~'~ir s s.~~
;
~ u~ ~-a~-~ ~r is.~t.~s
~ ~ ~ ~
~ ~s.~ r ~,~.~t
~ ~ ~/s s.a~w ~.~-~e ~~t~~a.~ ~rr zs,~.n
~
~
~
; ,
,
~ ~
~ ~
; .
;
I
,
,
+ PLACE OF FILING
' ~ ~S TOTAL S
~
~a'~~ ~
i
i
WITNESS my hand at Jaclcsomrille, Florida , on rt,;s,.
the lst dg, of MeY ,19 72 ~
600K PACE
.
StGNA RE ~ TITLE
i"
t Chief S cial Procedures Staff
OTE: CN ' cot~ o( offic~r wthoris~d by lar+ to toke ec4nowl~dywwms is net ~ss~~tiol ro 1M voliditr of Ndic~ d F~A«ol Tea Li~n G.CJiA.
26a~v . . t4sas~, ~ss.~
" ss
PART 3-To b~ us~d for racordinq purposes
1;~:-:: ` -