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'rorm d68 • CEPAititilENi Of TME iIfAAYmf-MEWK eE~'E~vtfE SEMCE ` For Cpeiaal U_se Record~ng OfRce
;aEV iao~ tERTWUTE OF RpEASE OF FEDBtAI ThX t!E!1
DI;TRICT ~~M~, SERIAL NUM6ER , '
2I6756 B196 P490 CLE1t~ tR,~Gy11 QOWT ~
1 hereby certify tfiat os to the foltowing-named toxpaye~ the requ'rrements of Section ~~0 Y~~t~~+~+~
6325(a), Internal Revenue Cocle, have been sa6sfied with respect to the taxes nnu-
mefated betow, together wilh a!I stotutory additions provided by Section 6321; ond
thot tha lien for such taxes ar.d stotutory additions has thereby been released. The
proper offKer ~n tt~s offe~ where ~otic~pf intemal revenue tax lien was filed on ~~'~V~O
Dct6~er i, , ~9 1, is hereby outhorized to nlake notatan
on his books to show the releose of said lien, insofor as the lien relates to the folbw-
ing toxes.
NAME OF TAXPAYER
~ ~s a i ~oa u. sQC~
~ RESIDEhKE
~ ~IQ'M~ ~i~• ~
UNPAID BALANCE
K1ND OF TAX TAX PERIOD ENOED ASSES.iMENT DATE IDENTIFYING NUMB6t OF ASSES'SMENT
' ' lal ro1 l~1 Idl lel
~ 1ioiA _ 1Z-~3r6d 1~-~-'10 ~6l?~T~-79~ 11~•~S
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PLACE OF FILING
a
E' ~ 1+1~'L~ OA1i TOTAL S~~
~ ~'t~. M~~wi lLt.
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WITNESS my hand at .Tat~kce~nvi 11t~~ Flnri a , on this,
` ~~~t~
t!~e _1~th_day of, .1»1 ~ , 19 72
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StGNATURE T1TLE
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~ (NOTE_ Certi6 e of officcr oothorized by law to toke ocknowledgmenls is nd asenti fo the volidiryr of Nofice of Federd Tax lien G.~.M.
~ 26419, C.B. 1950-51, 125.)
PART 3-To b~ vs~d for ncordin~ purposes kds
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