HomeMy WebLinkAbout1527 _ _ ~ z. . - - - -
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; o~r~Mert oF n+~ nEwquer-alr~c ~ve~ ' fo, qp+;,not w. er R.oo.a~ JI6~.
(REV. 1-701 ~T~A~ ~ ~ ~~Q~ T~ ~ f
DISTRICT - ~ . -
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; 1 hereb~? oeriif~r that as b Ihs falbwin8-rwmed iaxpoYer ti~e ro~iuirements of Ssction ~
6325(a~ IMernol Rsvdnue Ccde, havs beee salisfisd witfi resped b the Mxes aw-
' msrated bslo~r. ~ag~t~ with oll ~aluta~? additions p'ro~ ~'f~ ~ 6~1~ and
tbt ths lien for wdi :axaa and stotuMryl addii~~s has 11~eb'Y bee" ~'al°°ssd• ~ 9~~~
pr~ope~ ofRosr in ihe ofl'ioe whsre nofios. of ~brnal~ ranenue tan Gen was filed on w'ra7
, time 18 , i 9~23r is herab~? ou~horized to mdcs notafan
on his books to stww ~hs rdease of said tien, i~uofor as the lien rolates eo ths foflo~ .
~9 - r
IVAAAE OF TAXPJ~?VER .
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bl~rt ~ir. o
. . ur,P~ er?uNCE
qND OF TAX U1X PERIOQ ENOED ASSESSMENT DATE IOHYTIFYI ~ NUMBER OF A~S'SMENT
y ca~ ro~ k~ j
I s a~a.as
~ , ~ ~a~ ~ a~-~a .
~ ~a~r~ a~r.~ aar~
~ ~t r~~ as~i~~s ~2
PIACE Of RUPlG
a~~ TOTAL = _
~
t
WITNESS mv hand at ~k~g*"'t 11 e Flsrida -
the_Z~Z~.dar of~~~an:t , 19
OR '
SIGNATINtE M~
f
( T Cert~ficate of officer authorized by law to tdce ackrawfedgmen?s is no? esscntid ro tfie vdidily nf Nofice of e~:e~d Tmc Lien G.C.M. ~
2 9, C.B. 1950-S1, 125.)
PART 3-To ba used for nco~d'i~g pur~oses sd
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