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Brown 20670 a
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Form S6~ ~ U. S TREASURY DEPARTMEN7 - ir+re ~+ct 3E iCE l F~„ ;;x $r Reco;:.,y pti :r _ ~
REV. 8•57~ CERTIFICATE OF RELEASE OF F~DERAI TAX LIEN , F#tEa~?~r~ ~~~~p
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DISTRICT SERIAI N0.
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Jaclc,iomril~ 191669 Bk183 Pg2369 ttE~R '
1 hereby :.ert~fy thof os to the (ollow~ng•named toxpoyer thc requircm.enrs o~ ~ec~~on ~'~D ~
6325(a), internal Re+enue Code, hove been sotis(ied w~th respec+ to the tuxes cnu-
meroted be1cN, togethe. with oli statutory add~rions prov:ded by Sect~on 6?21; ond
that the lie•~ ~or such toxes ond stotutory bdditians hos the:eLy been re!ecsed. Tt~e i
proper of(icer in the off(ce where ~otice of internal revenue tox lien was f:led c~ !
Mareh 31~ , 19~Q, is hereby outho~i:ed to moke nototion ~
on his books to show the release of soid lien, insofor os the lien relates to the i
following to:ez_
NAME OF TAXPAYER ~Wi7r~+~ ,
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~ob.~rt a. ~ 8lisab~tb v. s~ill~.r ~~82'7
RESIDENCE
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P. 0. Be~ }21~5 +
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ClASS OF TAX UNPAID HALANC~ j
;Tax Return Form No.) PERIOD ENDED ASSESSMENT DATE IDEhTIFYiNG NUMBER I OF A$5=551A£N7
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aLt~CE OF FI~ING C~1~~ CS!'~~St CW!'C ~ ~T~~L i
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- St. Lnai~ Camt~ ;
Fort Pi~ro~, ~lorida ;
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'~r1TNE5S my fiand at T~rtiQ~~~i~Le, glnrida on th:s,
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_ the 24th dQy o{ APril , i9 74 -
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:IGNATURE ^ TITLE
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- J a~'E~~ Chief S ctal Proceduree Staff
; T Cer+ificore of off~cer ou+hwi:ed by law ro toke ockno.•ledgments 7s not essenhol to the voGd~tr o~ Notice of Fcde.al Toa L-- G.C.M.
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~3 PART 3--To be used for recording purposes .
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