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! U~!?i L~x41 CBCi~KAlE OF RBEASE OF FED~AI TA~ !~1
~
DISTRf SERULL NUMBBt
J~li~ g~g
1 hereby certify thot as to the folbwing-namsd taxpay~ the roquiremenia of Section
6325(0), Interncl Rev~er?ue Code, hove beea sotisf'ied with resped to the tcxes enu.
merated below, together with al) stofutory oddfions provided by Section 6321; ond .
tfiat fhe 1'ien for such roxes and srotutory addifions has thareby been roleosed. The j~D RE
~ P~P~ offic~r in the ofRce where notice of inierna! revenue tax lien was f~led ort ~~CIF COtI~~
~io.~s~ber 19, . 19_Zl, is h~eby authorized to moke ootution RO~ER Po~TA~a
' on his books to show the reloose of soid Iien, insofar os the lien relates ro the follow- C! ~~Iit C~RCUIT CBNRT
~ ing tmces. pr~~~ - ; : : , ,s .
~ ~ oF ~,Y~ ~ ~ ~ 2l IO 49 AH ~r3
. ~s~. m.~..
~ ~s~u~NCE 253083
~ ~ x~ ~ s~.Me
~ UNPAID B~ALANCE
j KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMB6t OF ASSESSMENT
; (al (~1 k1 idl tel
301~0 1=-3~?~0 6•1~•T1 ~64-ib-b?s9,~ i~,~.T?
PLACE OF HLING ~s~s ~
~
~ TOTAI ; Z~•~
WIiNESS my hand at _ Jsclunnville~ Flnrida , on this
.
tfie 23rd day of_~orr il . 14I3 800X~~ ~if~~,
SIGNATIAtE ~ m~
~f ' T~~ .
f cial soc durea St~ff
(NOTE: Cerf of ofFicer authorized by taw to toke acknowledgmenh is nof essentid b the volidi~r of NoticR of Fiderd Tmc lien G.CJ1A.
?b119, C.B. 1 SO-51, 125.)
PART 3-To b~ us~d 10~ ncondi~p pu~pos~s
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