HomeMy WebLinkAbout1160 ; 2589~1 ~ . .
Fenw ~D63 U. S. TREASURY DEPARTMENT - iNrEttH~t aEvEHUE SERVttE F« q~+,~~ u,.6~ a«..a~ or+.~.
i (ItEV. &67? ' CERTIfICAIE Of REIEASE OF fEDERAI ?Alt IIEN ,~~o
' DI57RICT ~ SERIAL NO. • ~E ~ •
~ 194395 8185 P195 t
i I hereb certi thot as to ths followin nomed tox ~
Y FY 9- poyer the r~quiremtnts of Saction AEC4PD Y:p°~I~O
' 63$S(o), Int~r~ol Revenue Code, hove been satis(ied with respect to the toxes enu-
meroted below, together with ali stotutay odditions provided by Stction 6321; ortd
rhot rhe lien fa such tuxes ond stotutwy additions has th~reby dsen r~leosed. The
proper officer in the offiee where notice of internal reve~ue tax lien was filsd on
; June 9. ,~9 ~s he~eby ourho~~:.d ro moke nato~~on 258921
on his boolcs to show the releose of soid (ien, insofo~ as the lien reMt~s to the
followiny taxes.
NAME OF TAXPAYER ,
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' RESIDENCE
; ~ a ~~O ~'M~ ~
` CLASS OF TAX UNPAID BALANCE
' (Tox Return Form No.) PERIOD EN~ED ASSfSSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
(a ) (b) (t ) (d ) (e)
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' PLACE OF FlLING
TOTAL S
~I~[ C~ ~0l~rj ~ ~ ~~s ~ tsllO~~ ~A~l~~
~ Jackaonville Florida
WITNESS my hand ot_ s , on this,
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` ~e 9th doy of July ~ 1973
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SIGNATURE TIT LE -
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J c rant Chief, Special Procedures Staff
E: C~~tificate oI officer authari:ad br low~ ro ~oke ocknowrlfdyments is not ~ss~ntiol to the va~iditr of NMic• oF Fed~~ol Toa Li~n G.C.M.
25119. C.B. 195051. 125.)
S~~R ~~.6 u~~F 1160 se
PART 3--To be used for recardiny pvrposes
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