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HomeMy WebLinkAbout0436 ~ _ ~ - -----~..,...,_-<~,~,-.,.~..~:.r.,.-~.-.~....,, . .~-_-.....~--_....--k..<_-.`..,....:.~--- : - , . ~ - . . ~.G ,t F~ l ` DE1AttMEM af 1NE T~EASI!!1t-~(IENAI: ~11E~1E SQYICE For Optionol Uf~ M RKa'dw~ O~ic~ ' ~RE1.1. 1-70~ ~h ~ ~ ~ ~ • . . . ~ - ~~20572~ 190 P2319 ~ ~ M~~ ' ~ Rcaa~e v a~r .~1 hereb~? oert~fy N~or as a ~hs fot~ow~ng~~omea ~u~oy~ ~he rpui~en~is of s.a~on - . . 4~25(a};r~lnternal Reveous Code, have i~ salisfed vmth ~ to the taxes erw- `J `6 ; n~ated,~below, ~oge~hsr vrith cl{ stotvtoll~ addrtior?s Prarided b'~? S~o^ 63Y1j ~d ; r 4 _ ! . M~ot lhs.•lien for wch tcxes cnd statutory od~itions; hos ti~eb~? besn ~aleosed. 1he ~ pt~o~ o~ in fhs ofRos whero no~ice of~enternd reven~e tax lien wos filed.on ,~1:.~ . 19_u.: -k F+erebr ouNiocized to dioice norot~on ~pAn ; o~ his baoks ro:tww H,s rdeose of soid;lisn,~itisofar as Mis Iien rolade~ ro rhs fdlow- ~v~~ ~ . in8 tax~ : - . NAMC;OF TItXPAYER . . : : ~ - RESID9~CE ' _ . . ~3~~ _ IN~PAID BALAPICE KlND .OF UX U)( PERIOD ENDED ASSES~MENT DA~ IDHJTIfY1NG NUMBHt OF ASSESSMENT lal rol (~l ldl ~°1 ~ 1~31~ 1i~-~3-'N ~iti~il~ ~ l _ _ _ - - ~ - - ~ _ . - ~ ~ • _ ; ~ ~ . y i - ~ f ~ ~ ~ i ~ f - ~ ! • - ( PIACE OF FILIhIG _ ~ ~ TOTAL ; i T~Ma ~ ~ ! ~ ; WITNESS my hond at Jacksonville, Florida on th~s, # 'p ± ~Q~X ~~e MGE 4~ ~ the 2~rd doy of October ~ 19 7G S{GNATURE T!T!E .~l~L~t~t ck DuranC Chief S ecial Procedurea Staff (NOTE: C' e oEF'icer outhorizsd by !aw ro toke «knowledgma~ts is not asentid to the vdidAy of Notics of federd Tax l~en G.C.M. 26419, C.B. 9~ 1, 125.) si ~ PART 3-To b~ usvd for recordin~ purpos~s - ~ ~ ~ j ~~V ~ _ ~ ~ ~ ~ ~ _ .'~~-°j- ~ , ' _ °