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fofm 66H DEPARTlNENT OF iHE iREASUeY-NTE~IAL tEVENUE SflVICE For C~Mionol Use By Recwdng Office
~REV. ~a~i) CERT~ICATE Of ~tELEASE OF fEDBtAI TAIC t1EN
DISTRKT SERIAL NUMBER .
W+w~l~1~i,~ ~d~ 3WS m ~'J~'1l -
1 hereby certify that as to the following-named toxpayer ihe requirements of Section
6325(a}, internal Revenue Code, have been sotisfied with respect to the taxes enu-
meroted_ below, togeiher with all statutory odditions provided by Section 6321; and
thot fhe lien for such taxes and stalutory odditions.has thereby been releosed. The
proper officef in the e where noti ~~n~`te~r al revenue tox lien was filed on
, 19~*; 1~hereby authorized to Make notation
on his books to show release of soidh~en, insofar as the lien relates to the follow-
ing taxes.
NAME OF TAXPAYER
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RESIDENCE ~ ~
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~ UNPAID BALANCE
KIND OF TAX TAX PERlOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(al (~1 kl tdl lel
2oip 1!9!-st~bl lQ-xl-?1 ~9i~oS-~6s~ ms~?-~
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~ PLACE OF FIUNG
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~ j~~ Q~~ TUTAL S ZQ~.'A
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~ WITNESS my hand at Y~~S~n~ , on 1his,
the 12th ~Y of dtUle ~ 9 'j2 .
frh~c.~•K ~~vT
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~ URE LE
aent H es Acting Group KRnager
, (NOTE: Certificote of ofFicer outFwrized br law lo jpk~ os,~r~N~ments is not essential to the volidiy of Notice of Fedaa Tox lien G.C.AA.
26419, C.B. 1950-51, 125.) QOeK ~i~ PAGf 64~
~ PART 3-To bt used for recording purposes ~ 'f'~~ a J
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