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I Fomi b68 ofMltrMErn of n1E tRFJlwer-N?Eewu REVEMUE SE~Vfte Fo. Op;onol the Br Recording OJboe
~ ~~rr. r.~o) ~QT~iUTE Of REtEAfE Of F~D8t1?t TAX llEN ~ c
f DISTRICT SERIAL NUMBER ;.IUCI C_
pE c~EaK
c a~ u~r coy~tt
I CORD YERI_ tED~
1 hereby cdfify thot os fo the following-nomed toxpoyer tlie requuements of Sechon
~ 6325(a), tnternal Revenue Code, have been satisfied with rapecl to the toxes enu. ' ie
! merated below, together with atl statutory oddiitions provided by Section 6321; and T~
' thot the lien for such toxa and statutory edd'~tions hos tfiereby been releosed. The
i proper ofi'icer in tha office where notip of intemol revenue tax lien wos filed on
~ October 20 9J1_, is hereby authorized to ~tiake notation ~
! on his boola to show the rele~e of said lien, insofo~ os the lien robtes to the follow-
; ing toxes. `
i NMAE OF UXPAYOt ~ Y~~~ 1~!j .
i
i
` s~~~NCE ~9 ~ ~d it
~
!ti. tl~e~. I~. ~
I
UNPAID BALANCE
, KIND OF UX UX rERlpn ENDED ASSESSMENT D11TE IDENTIFlfING NUMBER OF ASSESSMENT
; ~a~ tbI ~ kl cd~
~
~o ~.arr.~o ~
,
~
~
~
;
~
;
;
~
PIACE OF HUNG
; Gaic. G~ Cowt
L~t Gpw~ty TOTAL
Fort ~sres, ~iotlds
WITNESS my hand ot _ Jacksonville, Florida , on this,
~ the 20t h~y o; August ~ 9 73
,
~
SIGNAT T1TLE
4 ctC/ ~ ' cc .~f 1~
Jac D ant ~ Chief S ecial Procedures Staff
T: Certi6cate of of!'icer authorized by low to toke ocknowledgmenh +s not essent~ol to the vai~d~ty of Notice of federal Tox Lien G.C.M.
~19, C.B. 1950-5i, 123.)
~r.RY 2~_~ PAGE~~ / V pART 3-To be used for ?eco~ding purposes kds
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