HomeMy WebLinkAbout1798 _ _ - . - ~ - - . . - - - - - - -
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fortn E68 oEVAitrntEMT CF tt~E lT~wer-NTfwAt nEVEwuE SENKE For Oprionol U~e By Recwdng OR'ice
~-~o! CfRT~IGTE Of REtEASE OF fEDBGt TAX UEN
ciS~R~cr sERt~ NunneER s
_ ~~ws 217830 D196 PZ022 +~N~ ~ ~
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1 herebr certify that as to the foltowingnomed taxpayer the ?equirert~enis of Sec~ion }~i'~Fi~p~
63?5(oj, lnternal Revenue Code, hwe been sofisfied with respect to the taxes enu-
merated betow, together with a!1 stotutory odditions provided by Sectioo 6321; and ~7~
thot tfie lien for such taxes and statutory additions hus thereby been reteased. The ~ r
proper of~icer in the oASce.where n;~e7qf enlernd revenue tox lien wos filed on
October 28~ , i,~ h~eby authorized to niake nototion
on his books ?o show the releose of said lien, inwfo~ as the lien relates to the follov?- isa.
ing taxes.
NAME OF TAXPAYER ~ ~ ~ ~ ~ -
RESIDENCE ~
~het !'l+~a+~~ lLrl~i~-~ -
uriPa~ a~?ur~cE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTtFY1NG NUMBER OF ASSESSMENT
(a! rol (~l Idl k1
Loyo u-ri-To 5.~,-~rs 3!~-~a-~e?~t ~,~.st
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F PLACE OF FIUNG ~a~~t ~,e
~ ~ IOTAL s l~~u
.T'~i. ts~M f
~ WITNESS my hond at Jackaonville, Floridl , on rh~s,
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20tt~ doy of June , i 9 72 -
; SIGNATURE T1TLE
--g~'r.~~z~.-
; Ja ant Chief S cial procedurea Staff
(N : Cerfificote of officer o~tiwrized by law fo take xknowEedgmenh is nof aseotid to fhe volidify of Notete oi fede.ol Tnx lien G.C.M
26419, C.B. 1950-S1, 125.) s.
` PART 3-To b~ vs~d f~w ncordin~ puepos~s
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