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Fo1m 053 . DEF~f'i1MFNT qf TkE TRfASI}Rr-NTEfcN/ll [fVENUE SEI6'1CE Fa C)ptqrwt Use 6r Reco~d~ng Office
fR~V. '•~a) CERT{RUTE OF REIEASE OF FEDERAL TAX UEN
;~I;TRI~T SERIAL NUMBER
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i hereby cert~fy thot as to the foliowing-~wmed taxpayer the ~equiremenls of Section OGEF Pa~T~Af
~ 6325(a), Internol Revenue Ccde, hove been so6sfied with respect to the taxes enu- w~CORp yf 1Eb~~
me~ated below, together with all statutory additions provided by Section 6321; and
that the (ien for such toxes and statutory addifions hos thereby bee~i releosed. The ~ 9~ A S3
proper oflicer in the offxe where notice of internal r~venue tax lien was f+led on w "
_~pril
14 _ , 19L, is hereby authorized to ntiake notation
on his books to show 4he ~elease of s~id lien, irtiofat os the lien relates to the fol!ow-
ing taxa. ' - .
NAME O~ UXPAYER
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lCTr
RESIDENCE
P 0 ~t )66 ' -
l3+~ei~ jtTld
, UNPAID B~AUNCE
KIND OF UX TAX PERIOD ENDED ASSESSMENT ~ATE IDENTIFYING NUMBER OF ASSE55MENT
lal t~l (~l tdl l~)
941 '~oat ~-~13-?t . 9i6-o~-7~i6t l,~Oi.dd
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! PLACE OF HUNG ~ ~,t
~~'A~ A~l~ TOTiA~ S 1~~~
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' WITNESS my ho~d at Jackaonville, Florida , on rh~s,
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rhe ~9~_day of June , t 9 72
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SIGNATI~tE T1TLE
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Jack Dusant Chief S ial Procsdura• Staff
(NOTE: Certificate of oR'ice? ovthor~zed by law ro toke ockrawledgmenh is not ase~iol b the volidiy of Notice of federd Tax lien G.C.A~t
26[19. C.B. i950-S1, i25.) M
~ PART 3-To b~ us~d for nsor~rp pu~~wses _
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