HomeMy WebLinkAbout1797 . ~s oEr~xr~Nr o~ n+e n~~suer-++r~eru~ ~v~x~ sEe~ Fo. oa~o~,o~ u,. er R«a.d~~ o~e
jt~v~,~=TO) CBtTEiG1E Of RELEASE OF F~DBtAI TAX tlEN ~
DISIRK'T SERIAL NUMBER FI~E~ k'~ .'r~~aOED
219118 Bl9 ST~~~~~f -yJ~NRAStA.
Rc~c: - ; couat ~
I herel~y ce~efy thot as b the following-~Omed taxpaye~ the roquiremenh of Section ~.u~
6325(aj, Internal Revenue Coda, hav.e beeo satisfied with respect to the toxes eeu- Q: rrc ~
meroted bebw, together with all statutory addfions provided by S~ectio~ 6321; ond ~ 53 Ah
that the lien for such taxes and statutory addi6oru hos thereby been released. The ~ Z j 1 L
proper o~~iq the Qt£ice where notice of i~i~emal revenue tax lien was 6kd o~
1blr 19 ~ 19~~, is heroby authorized to make notation
on his books to show the release of said lien, insofar as the lien relates to the fdlow•
ing taxes.
NAME OF TAXPAYER
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RESIDENCE 1~ ~
!~'t rl+~Il+M, ~~-~3~
UNPAID BAIANCE
- KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSMENT
(a) . . (b) kl ld) (e)
~ 9h~ 1t-31~-6+! 1~-09-Ti ~ ~l~-119t~0~ ~.dt
! 91~3 i~-3~-70 1~o9~-n 59~-si~o~ ~6t.~T
6
~
~
~
~
~ PLACE OF FILING
~ C1+~sit, Cis~a~is C~wr~
: a~ y,~ TOTAL s y~~
1K. rs~r~. Fi~a.
3Y+i
~
e.F
~a
~ WITNESS my hand at Jacksonville Florida , on rh~s,
~
the 19th ~Y of June , 19 72
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~ SIGNATURE ~E
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Juk r t -
° (NOTE: " ca?e of oIF'icer autFwrized by taw to ta~e acknowledgments is not asentid ro tfie vaiidity of Notice of Federol Tax lien G.C.M.
26419, C.B. 1950-51, 125.) ai
PART 3-To be usod for neoedi~p p~+rpos~s
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