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p~ .ti ~g • U. S. TREASURY DEPARTMENT - o+TEr+n~~ aEVENUE sEav~cE Fo. Ovr.a,o1 use er Ra~o.d~.q 0/~~ce `
; R's s-~. . CERTIFICATE Of RELEASE Of FEDERAI TAX IIEN sT. wc~E cou Y f~
~ISTRICT SERIAL NO. ClE KCCi~CU1T OURT ~
188503 B182 P965 RECORO YERtiIED~,~
1 herebr certify thot os to the following-nomsd toxpoyer ihe requiremsnts of Section
6325(a1, I~ter~al Rev~nue Cods, hove been sotisfied with respec? to the toxss enu- ~Ee ~ ~2 sa PN y~~
m~roted belcw, together with oll sretutwr odditions provided by Section 6321; ond
thot the lie~ for such toxes ond statutwy odditions hos thereby been rtleosed. The
proper officer in the office where notice of internol revenue tox lien wos filtd on ~~~~1~ -
TAn~inrv 19~ , 19 7~ - is hereby outhorized to moke nototion ~
on h~s books to show the ?eleose of said lien, insofor os the lien relates to the ' '
followiny tazss.
NAME OF TAXPAYER
$ZD~ ti. lfiiti~l' P~Od~~i
RESIDENCE
31t31 80• L~dia~1 Ril~s~' D!'i~~ ~tr~ tiOS~M~ !]a~+~50
CLASS OF TAX UNPAID BALANCE
(Tox Return Form No.) PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
' (o ) ~b? << ) (d 1 (c )
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~ 9~1 6+3~-~l~9 8-5-69 ~-~+~wJ33 ~S2Y6~~T
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~ °LACE QF FILING CLZ't~ C~11~L C~'tr
$ts ~lQ~ COiM~' ~ TOTAI S j~2~•ZT
rt. PL.roe, na?.-j ~ ~
Jacksonville, Florida _ , on th~s
WITNESS my hand at ~
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~ rhe 5th d~y o{ February ~ ~q 73 ~ Z~jIK~~
5:4
~ SIGPiAT E TITLE
r-
;~a Chief, Special Procedures Staff
NOTE: ~~~~core of ofFicer outhoriaed by low ro toke acknowledgmer+ts ~s not essentiol ro the valid~ty o~ NWice of Federol To¦ L~en G.C.M.
- 2h1 , .B. 195051. 125.)
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PAR7 3-To be used for recording purposes
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