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~~v i-~o) CERTWGTE OF RELEASE OF FEDQAt TAX UEN .LVCi~ ~ou~rr ~sw_
DISTf~C,T SERIAL NUMBER • ROC~t' z1t~ltxf
~IERK Cli'~:Uli ~'.DIIItT
F?~ YF ~ f ~E~.~,~.
r,,,:,.:5y certify that as to the following-named taxpoyer the reqvirements of Section ~
6325~a), Internal Revenue Code, have baen satisfied with respect to the taxes e~u- J~ ~]~j
merated below, togetF~ with all statutory additioos provided by Section 6321; and 23~ •7~
thot the lien for such taxes and stotutory oddifions has M~ereby been released. The ~,yc~~~
proper officer in o where noticeQ mternal revenue tax lien was filed on I~r I p
~ te
October~ , ~q K~y a~~orized to make rwtation
on his books to show the release of said lien, i~aofar as the lien relates to the follow-
. ing toxes.
NAME OF TAXPAYER
RESIDENCE
~ti ~
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
~a~ ro~ (d) Ie)
~e tt-~1•72 Oi-~T~ ~Ti-li-OSl3 !Al.ls
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~ PIACE OF FILING
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SL LuCie C~y TOTAI s 9».1S
Fat P~ence. Flortda
WITNESS my hand at Tacksonville Florida , on this,
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:~a~ the ~_day of March , 19
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~ SIGNATURE T1TLE
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(NOTE: CertiA e of officer outFwrized by law to toke ocknowledgments is not essentiol to 1he vol;diy of~Notice of federal Tax Lien G.C.AA.
~ 26419, C.b: SO-St, 125.)
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PART 3-To b~ used for recordin~ purposos
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