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F~ ~ OHNtTMENf OF l1E 11fAStlRY-NiEtNK REVEMIE SE~MICE Fo? Opfio+al Uu dy R~wd'+8 ~'a
(REII, 1-70) ~~QT~AT~ QF ~EA~ TwX ~ iT. ~YCiE Z~MZY f
DISTRICT - SERIAI NUAABER ROC~i~ ?01TRAS
~ M! 2 6 2 RFCORO VE.Ri
tEQ C~T
I hereby ceriif~? that as ro the folbwing-nomod toxpa~rer the requi~nenh of Section
6325{a). INemal fEevenue Code. have been safisFed with respsct ro the taxes enu- ~j Zj ` 10 i H~~~
• merated below, togeN~ with cll statutory additior~s provic3sd by Section 6321; ond
that the lien for such roxes ond statu~ory addtions hos tl~ebp been releosed. Ths ~
~ proper oi~ in the oifioe where notxe of internol re~renua tax lien was filed on ~~~~U
une 2 , 19.1~_. a ha*eby autFwrized to NfakR notoiion U
on h~s books ro sFww ~he release of sa~d t'~sn, insofor as the fien r~ ro the fdbw-
in0 to~oes. - "
N/11~IIE~~ 8 ~ ~ S ~
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pi. ~sa Pts.
UNPAID BALANCE
~ KlND OF TA)( TAX pER10D EPiDED I+SSESSNIENT DAZE IQENi1FY1NG NUMBESt OF ASSESSMEPIT
~ ~a~ ro~ ~a) Sef
I` Ip~p - 22-3i-T3 ~2a-'7~4 ~f+a-34~'~1~t ~s~'~
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~
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~ncE oF Fiur~c Q~k~# ~t
~ TOTAL = 1~~~~
- ~ ~ l~t. 33~0
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~ WITNESS my hu~d at Jacksonville Florida _ , on tfiis,
the 21st ~y of June , l9 ~4
SIGNATURE , ~ T1TLE
~ ' ~ r .lt t! ~
Jack r Chief, Special Procedures Staff
(Np;C' cate of officer authwized br law to toke ockrtowledgmenis K not essential to the vohdity oI NoticP of Federal Tcx Lien G.C~
26419, C.B. 1950-51, 125.)
PART 3-To be vsecl for recwdi~g purposes p~
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