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t'Ofrt1 GG9 OEPARiMENT Of iHE TilEASURY-NiERNAI REi/ENUE SERVICE OPno~w1 ux 9r R«wd~ o~e
~a~v. ~.~o~ CERTWUTE Of RELEASE OF ~EDHtAt TAX l1EN
p~~p~ SERIAL NUMBER F~~Ep At~f; KECOROED
~~~l 203905 B-189 P-2552 aT.l.uC~E ~ouNTY flA.
I hereby certify that os to the followingnamed toxpaye~ the requiremenls of Sectioo ROCE~ ~d?~RAS l~
CIfRK C?~:GUiT COUitT v
6325(a), Internal Revenue Code, hove been sotisfled with cespect b the toxes enu- pECOR~VFE< =sEO
muated below, togetl~er with oll statutory additions provided by Section 6321; and ?
that the lien for such taxes and stotutory odditions has thereby been ~eleased. The ~~p 2 Z7 PN ~ 1 Z
pro officer i thg of~ice where nofice of internal revenue tox lien wos filed on
ganuary ~8th , 19-1~is hereby authorized to nioke ~otation
on his books to show the release of said lien, insofar as the lien relotes to the folbw- ~;.~.r.,K~
ing taxes. ~ ~~r
' NAME OF TAXPAYER
~i~t]~s a. ~ ~rs~l~w ~q
~SIDENCE
r !ai s.~ s~ ~ssrrt
~ Tre~t ~s ~
UNPAID BALANCE
KIND OF TAX TAX PER10D ENDED ASSESSMENT DATE IDENTIFlfING NUMBER OF ASSESSAAENT
(a) lbl kl Id~ lel
~ 10i0 Iaor 1i~1-6! 6-3-70 SSl ~0 17~ i aM.l1
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~ ~s f~ a r~i!!y llrtyw ~f r~i~sal
!~a L1~ w J~rr~ i!?1 i~ oEEf~si~l
i~~d ~w1t s ~liM i3~i !s ~s ~t dis
~ C3~lt ~t ~s a~st ~iir 1~~af~ ~rr¦~~?•
Ti~ei~ !s t~s ala dit
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o~tsl ~w ~s aMs w t~is
* PtACE OF FItING
~ CI~~ C~L TOTAI S ~,~n
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" ~'iet !la~+¦t. *Leida
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Jacksonville. Florida
WITNE$$ my hond ot , on this,
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rhe 29th day of June , 19 72 ~
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~ SIGNATURE TITLE
Jack Dur t Chief, Special Procedures Staff
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_ (NOiE: Cert~ficate of off:e. o•~}f-o+;ze~ o~ .:w to tcke cknowledg en s~s . ~ essennol to the vohd:ty of No~~ce of Fede?a! Taz Le~ GC.M.
~ 46419, C.B. 1950-51, 125.) G~ ~.+Vv
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~ PART 3-To be used for recording purposes
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