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Fann 668 U 5 TREaSURY DEPARTMENT - ~~:TE~k~~ REvEauE SERV~CF ~ ~ ~r Us~ 8r ~c•o-_:~; L~:.e
,Rt~. ;-F>> CERtIFICATE OF REtEASE 0~ fEDERAI TAX LIEN ~
D I S? R I C T S E R I A L N O. --}l---- - LED AN y R• 4~
yr Q~~. -
~ua+r ~ov T f
,jjQ~ 188502 B182 P964 OtEi~ i~)j1RA5
i hereb certif that os ta the Followi~ n:med 1ox o er ttie re u~rements of $ecfion a 4 G R K G t' U 1~ C O ~ R t
Y Y 9" P Y 9 RFCOkb Yk f P F~
63~5!0), internoi Revenue Ccde, hove been sotis~~ed w~tF respert to the taxes enu- ~
meroted belc~, togethe+ w~th alt stotutory oddit~ons provided by Sectie~ 6321; ond ~ 13 ~Z ~M 1~~
thot the I~e•. 1or sucb tozes ond stotutory additians has *hereby bee~ elecsed. The
proper of(~:er in the o(f~ce «he~e not~ce of ir.".ernal re~enue tox lien was f:led on -
Januar~r Z9L ,~9 7~ ,~s hereby outhor~zed to moke nototion 243609
o~ his books ~o show she .eteose of soid lien, i~sofor os the lien relotas to the
following foxes.
NAME OF TAXPAYER
.TOIiR Dr ~ R~Q~NZ 1~i~1~Ot -
RESIDENCE '
lbos is~ ses~.e
Fs~t l~s~es ~
CLASS OF TAX UNPA10 BALANCE
!Tox Return Form No.) PERIOD ENDED ASSESSMENT DATE IpENTtFYlNG NUMBER OF A$$ESSMENT
(a) fb) (c) (dl ie)
~o ~_31-6e s-~69 21~.26-zo7o 5335.~9
E
~
F
F
~
W
~
~
~ ' .
~
dt
~ ~ - -
~ PLACE OF FIUNG
C~~s C~~1{ ~ TOTAL s 335~~
$t~ Z~IC~ ~
~ to~rt Pl~ro~~ ~'Lo:'id~t -
~
~
~ w~TNESS my hond ot Jacksonville. Florida , on ih~s,
~
~U rhe 6th dcy of December ,19 72 -
~
SI ATURE TITLE
~
~ ~
~
~ - Chief ~perinl Proced~rg~ 'tAff
~ OT . Certi(icote of o cer ov~hari:ed by law ro toke ock~ov.ledgmen~s ~s ~ot essen~~ol to the wolid~ty o+ Not~ce of Federol To¦ L~en G.C.M.
~ 2 9, C.B. 195d51. 125.)
G x~ PART 3-To be used for recording purposes 8s
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