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Fora~ 668 U S TREASURY ~EPARTMENT • iw*EaN~~ QEvENUE SERyKE Fo* Oa~ N~~ Use 8y Recwd ny Oi~~c~
; (REv~ 8•67: CERTIfICATE Of RELEASE OF ffDERAI TAX UEN r~ R
DISTRICT SERIAI N0. ~t~Q ~ Q
185765 BK. .2 Q4 Rf
i hereby certify thot os to the Folfow~ng-named toxpoyer 1he requirements of Section ~'A ~~~e
Q ,
6325(0), Intema) Revenue Code, I+ave been satisf~ed with respect ro the toxes enu-
' meroted belc.., !ogether with oli statutory oddifions provided by Section 6321; ond pM
that the lie~~ sor sucF~ taxes ond statutory addifians hos +hereby been released. The w ~
proper off~cer in the office «here notice o( internol revenue tox lien was f:led on ~w~~~
November I8 , 19~2Q_, is he?eby outhorized to moke norotion v
on his books to show the release of said lien, insofar os the lien relotes to the
following toaes.
NAME OF TAXPAYER 1
~u Z• ~t rililyll~ ~1'~
RESIDENCE
91S ~aa
CLA55 OF TAX UNPAID BALANCE
(Tax Return Farm No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
. (a ) (b ) tc 1 (d ) (e 1
~ 1Wro 12-33~ S-Yj-b9 ~86-~-5992 il.b9k.~!
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?LACE OF F!LING
$~r~~L~~.~Mi~ ~iOYl~ TOTAL 3 1~~~~
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~0~1"~ M~00~ ~!'s~i
WITNESS my hond at Tack~onvi 1 1 g, F1 nri ria , on this,
the_ 5th day of October ,19 72
L~
SIGNATUR TlTLE
J u ' hief, Spec~l, Procedures Staff
NO . e.~iFicate oS office~ a~thdizr6 by lo+ to ta4e acknowledgmen+s ~s not essent~ol ~o ~he volidity of No~ice oF Federal To~c L~en G.C.M.
19, C.B. 195P51, 125.i .
bec
PART ~To be used 1or recording purposes
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