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Forn? 668 - oEr~+~r~Nr oF n+e n¢wsuin-.~~ eeverue sE~ w? op:o~d u,. R.cn+dr,~ olFc.
+~v i-~o~ C~T~KATE Of RILEASE OF fED8tA4 TAX L~N it. WCIE C tr
DISTRICT SERWL NUMBER ROGEit P01?RA!
241139 Bi ctEaK c+RCUn ~a~t
RECORO VER~FIEO.~.~~~
I hereby certify that as ro the following-oamsd raxpoyer the requiremenh of Section .
6325(a). Internal Reve~ue Code, hove beer? satisfied with respnct to the taxes enu- ',te ~~'3
merated below, together with all statutory additions provided by Section 6321; aed ?y
Nwt the (ie~ for such taxes and statutory addi6o~s has therebr been releosed. The ~rYVJrs I ~U
proper of~ in the ofF'ioe where notice of inkmol ravenue tax lien was filed on ~~~*t,~`
November 1~ 1972_, is hereby authorized to make notation
: on ha books to show the releose of said lian, i~uofar as the lien relates tn the follow-
ing taxes.
NAME OF UXPAYBt
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RESIDEtJCE
7~ ~ ~
Paet P~+aa~ii 33~~t!
UNFaD BAUNCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBEIt OF ASSESSMENT
~i la1 lb1 kI IdI le)
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~ 44i ilitt~idir~p 12-31-7I Q4•03~T2 ~1~~ i ?,57.86
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_ ~ CS~l~'Z GOIirL TOTAL S 2?'~7.88
9~ Zi1G~~0 ~`i01iYL`y
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~ WITNESS my hond at Jacksonville Florida on this,
The 19th ~y of January , 19 ~3
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SiGNATURf~ , TITLE
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Jac n • Chief a
X~ t E Cert~ficate of olficer outhcrzed by !~w to tiKe ocknov~ledgments is not essentiol to ihe valid~ty of Notice of Federal Tax Lien G.C.M.
6419, C.B. 1950-51, 125.) R~ SS
PART 3-To be used for reco ~ng purp3ses
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