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F~~ ~t~ U. S. TREASURY ~EPARTIAENT • IHTERNAL REvENVE SERVJCE Fo. Oor~onel Ust B~ R~cerlr~ ONa~
~-ev. e-6» CERTIFICATE Of RELEASE Of FEDERAI TAX UEN ~
DISTRICT SERIAL NO. .
' 187070 B-181 P-1998
1 h~r~by c~rti(y tF~ol os to ths (ollowin9-nam~d toxpoy~~ th~ r~auir~m~nts of S~ction
6325(0), let~rnal Rev~nv~ Code, hove b~en sotis~i~d wi~b resp~ct to tbe tox~s eou- '
w~trot~d b~lew, to9ether with al) statutory odditions provided Sr S~ction 6321; ond Lf~ A i
fFat th~ lien fo~ suth toxes ond statutay additions has thereby been releas~d. Th~ R~~~
prQp~r oifice~ in jht office whar• notice ol intsrnol ~~venw tox lien was fil~d on n~ , ~IRCUIT C01~~ ~
UAC~b@Y' IbCtl , ~9
69
_ is her~by outF~ori:~d to moke nototion ~r~ 31FIEO~
on his books to show th• releose o( soid liso, insotor os t6e lien ~elates to th~
Fol~owinp foz~s. ~ i i S v9 aN' • Y
NAME OF TAXPAYER J~ 8~ a~~ A~,~~
RESIDENCE p ~ ~ ~j
!'t PI~Cii ~l. ~y0 ~
CLASS OF TAX UNPAID BALANCE
rToa Return Form No.1 PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(a ) ~61 (c ) (d l (e )
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~ ACE OF FIUNG ~~~t ~
~ sL. ~.Y~a C0~1~ TOTAL S2s~•1T
~ ~'t. Pi~'e~, lloTida
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~ '~ITNESS my hond ot Jacksonville, Florida , on this,.
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~ rhe 17th doy of ADril i9 73
~ ~i~ ~ TITIE
L L~ c' j~ i(iG : Q vc . i~ -
~ ~k Durant Chief, Special Procedures Staff
~ ~(NQTE: CertiFicare of officer authai:ed by law to toke ocknowledgmer+~s ~s not essen~~al to the validity o( Notice o( Federal Ta¦ L~en G.C.M.
2b~19. C.B. 195P51. 125.)
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- PART ~To be used for recording purposes
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