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FO~a~ ~8 U. S. TREASURY OEPAR~MENT - INTERNAL REYENUE SERVI~E Fw Q~r,onaf Use 8g RecorduyOkrce
fREV, &67f tERTtfICATE OF RELfASE Of FEDERA! TAX 11EN
DISTRICT SE~t I~r~p
llwi t~l~ar~ La. M~3~7 196598 B186 P288 CP
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1 hereby certify Ihot as to the (ollowiny-~omed taxpoyer the requ'utments of Seciion a`~ K~~,~ ~~VlT ~raVAT ~
6325(0l, Internol Revenue Code, hove been sotisfi~d witl~ •espect to the toxes •nu• AECOND Y%~i~ilE~~
me~oted bslew, together with o!I stotutory additions providad by Ssction 6321; ond
tF~ot the lie~ for such toxes ond statutory odditions hos thereby been reisased. The ~~t ~n
propsr ofJu~ry n2t~+e office w6ere notic~,p( i~ternol revenue tox lien wos filed on ~ M
_ 1 9, ,~9 V ,;s hereby authori:ed to moks ~oto~;o., 25892z
a+ his books to show the releose of soid lien, insofar os the (ien relotes to the
iallowinp tox~s.
MaME OF TAXPAYER
1~ ~`IS QQ~1lM~ ~
RESIDENCE
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CLASS OF TAX UNPAID BALANCE
(Tox Return Form No.} PERIOD ENQED ASSESSMENT DATE 1DENTIFYING NUMBER OF ASSESSMENT
(o ) ~b ) (c ) (d ) (e )
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ro~ t~~+~ si'~.s
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~ PLACE OF FILING
TOTAL S
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; WtTNESS my hand at_~~~,,~Eee~v~-llarF-lor~da , on ih~s,.
i
she 9th doy of July 19 73 ~
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SIGNATUR TITLE
i
; r Chief~ Special Procedures 3taff
TE: Certificote of off;ce• au+hori:ed by law +o toke ocknowledymenrs +s not essent~al to +F+e vol~dity of NWice pf F~d~rol To~ Lie~ G.C.M.
2b119, C.B. 195d51, 1Y5.1 g~a~ ~'CF 8s
PART 3--To be used for recording purposes
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