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FOr111 66a U. S TREASURY DEPARTMEIV? - IMERNAI REYENUE SEA'VICE Fx OWiawl Ws avcaAiy OH7w
' IREV~4-l15J CERTlfICATE Of OF FEDERAL TAX U~1
i c1y
+ DtSTRICT ~ SHtlAI NUMBEk /~(jp /S/VL/ .
Ja~M~tl.1L~ ~sii1 151126 B162 P229
~
i i hereby osrHfy tlwf os to the fo!lowing-nornsd foxpoyer t}~e requ~rements of Section 6325(0), fILE;? '~itGtiRDE~
E Internol Rw~tws C,ods, hove been satisfied with rcs $T. ~l~':~' 'QU!i11' flA.
~rxd to the taxes enumeroted below, togcther F~. T=~$
' with all sfatulory odditions provided by Section 6321j ond tFx~t the lien for wch tazes ond it.E=' ~G•~ ~i~~`R7
i stoturory additions hos thereby been refeased. The proper officer in the office whare rqfice o( S',- .~••~~S
, intefno! re:~nex fmt licn wos filed on December 2~ , 29 bb , is hereby ~r ' 09 ~
authorizsd to rtwlc~ ~wl~ntion on his books to show the release of said lien, Insofar os fhe lien
relotes to th~ foilowinp toxes.
~ NAME OF TI?MAY6t
, s~'ti"~ 26'7520
~a,~ ~ ~ ~
S~T r. i7~ st., rbrt r~.ro... -s3+..•33b9o
~ ~ T~ UNPAID BAiANC'E
(Tax Retum fonn Nal PfRIOD BdDED ASSESS~MIEM DATf IDH~1i1FY1NG NUMBER OF ASSESSMB~Ii
tal Ibl fd ldl ~s1
~ t91~) a~al. 1463 ]A-]1r6b ~~6~,3~l6T~ioto y~.ci9
~ ~ t9l~3} 196~ ~-]l~-66 59~3t6730~1 L03.91
~ PtACE OF FlUNG ,
~ ~ L1M~ G~~~ TOTAI S
' ~i~ ~ •
W(TNESS myhand at Jacksonville, Flor ide
, on this,
the 24th dayo; October ~ ~q 73 -
D!STRICTDIitB(,'TQ1tQF IMERf~1AL REVHJUE 8Y Sigyoturel / TfTLP
~~~r~',C". -c . tc 1 ~ ~c !J . Chief, Special
'Donnell Jr. a Durant procedures Staff
MO'rE: G~tiflcole of ofHcer avthorized by bw to to Sdcnowtsc~ments is not esse~No1 1o ths whdiry of thts docvmerk. G.GM 26<19, CB.
1950-1, 145.)
~(}R{ r~j,t ~ 2~ PART 3-To be used for recording purposes kd s