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HomeMy WebLinkAbout0278 - - - . . _ . . . ~ ~i ~{.F U. S. TREASURY DEPARTMENT - INTERNAI REVENUE SERVICE F• Opiwl Ua~ 8r R«vJ:y ON~c~ t.EV..~:.a~ •CERT~KATE Qt RELEASE Of f~EtAl TA~ l1EN ~f :Q DISTRICT SERIAL N0. ' - ROC~R It~ - ~K *,~s •QLERK CIRCUIT 4!ltlllT 1 I+K~by cKtif~r tiwt as fo fl~ followinq-nen~d fexpe~rK•tM rpuir~w~*s e~ S~ctiae ~ECORO VERiFIfO~~~ ~ 6325(e), let~ma) R~v~ew Ccd~, hov~ bNn sotisfi~d witl+ nsp~et t~ ~F- :ox~s ~eu- ~y d~ iq~ f w~~raNd b~low, to~tMr witb oll stotvtoryr edditions provid~d. br Stetion 6321; ond ~ i.41~ 1~ # L~~ ~ tlat th~ (i~n fw sucb tos~s and stotutoryr additions las th~nby b~~n ~~I~as~d: TM ~C/~'/~ ~ prop~r ofFie~r in tM offiet wh~n eotie• of int~nal nwnw tox li~n wos iil~d on V`~V`3 ' _ytw»t ZStli , 19~~, is M~•br ouiho~~:.d to n~ok• oobr~on on his books to show th~ r~ltos• of soid li~n, insofar as tM li~n r~lat~s to tl~~ followirq tax~s. ; NAME OF TAXPAYER Ge~g C ?f~~hi2l ` R ESI~ENCE ~ - : :sost Office Bo~c 3~-•`1 . UNPA10 BALANCE TAX FORM NUMBER PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT (o? (c) (d) (e) . . ~ ?:~'4 Inca~e 12-31•t~t`i ~4~G7 ~62 36 5794 5 1~~6.59 ~ ~ PLACE OF FILING ~AT~~ ~~i'Gii~'t ~O~Rt TOTAL S 1~4Q~•~ ~ ~ ~~4 ~O{~y - Tttil`t ~@!CR $1Ck!'Zd3 ~ . NOTICE OF ~EDERAL TAX LIEN REf1~IN6 B_211 p-409 ~ IRS SERIAL NUMBER ~n RKORDER'S IDENTIFIGTION NO.__ Z4~O6s Cle~rk~ C~'r~uit Cotst 2/19/73 NOTICE FIIED WITH SL~ Ii~cie~ C~affitv~T~Q~~_~.~t~i DATE . TAXPAYER'S ADDRESS g1a?A li~12,~l~~. Fart ~'ia~es F~~i~L ~ - (if different thon shown obove) SIGNATURE ' ~ ~ ~ ' ' - TITIE WITNESS my harrd ot JiCk~OtWiil~~ ~~+0l1~ , on this, ~ the llt6 d~ ~ Nsy ~q-73 ' SIGNATURE _ TITLE ~e~' Spsciai Procadur~a Statt . Dut'atlt ~NOTE: Certif of o~cer aufhorized br law to take acknowledgments is not essentiol to ffie validitp of Notice of Federal Tax lien G.t.M. 26419, C.B. 1950-1, 125.) w~^ b ~oox2~4 ~r~t p PART 3--To k~a used for r~co~ding purposes ~ _ g - ~ ~ . ~ g r ~ ~ - ' ~ ~ ~.~'a•s~,.*s. :3`" f . ~ ~+a x-~`-