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Fwm~Z OECEOENT'S FIHST NA~tE AND ~AIDDtf INITIAL OECEOENT'S UST NAME
IRsv. Oct. 19701
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~ OECEOENT'S SOCIAL SECURi7Y NO. EMPLOYER IDENTIFICATION NUI~ER ~ATE OF DEATH
FORESTATE
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RESIOENCE iDOIWCIlE1 AT TIME OF DEATH
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United States To
Certificate N~.~~ ~
APPIiCANT ,
Releasing AODRE55 C~ ~~~t~
Estate Tax Lien 5~,..`, p. o. e°~` 6~'
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1 certify that the estate tax for the above decedenYs estate has been fully paid or otherwise provided for. This
certificate releases the lien of the United States irt~ed by section 6324 afi the Internat Reveriue Cude on the property ~
. tiescribed below: _
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