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i f DHAtTN1EN~ af ~ TREAS41[I-~liEWAt lFVENUE SfRVICE fQf Opf~lO~ Uf! Ay R~OOft~iny ORx'~
' I~-T01 CBtTINGTE OF RBEASE OF FEDBtAI TAX UEN ~
, DISTRI~T SERULL NUMBER ~
~t. 285710 Bk229 p 496
; 1 herebr cerlify ihat as ro the fdlowin8-nomsd taxpayer the ~equirements of Section !1j~~
~ 6325(a), Iniernal Revenus Code, have been sotisfied with respect to the taxes enu- a~W
rr.erated below, together with oll statutory oddfions provided b~? Sacfion 6321; ond
i H: ~t the lien for such taxes ond statubry addfiaa Fws thereby been releosed. The
! p~bper ~n the ofi'ice where notice mfernul revenire tax lien wos Bled on
i - . 19 is hereby authorized b make notat'an
! on iis books b show the release of said lien, i~aofar as the lien relates to the foltow-
` ing tmces.
i
NAME OF UXPAYER
~ ~!!jM ~~9~~i i$i~~
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RESIDEt~CE
~ ~ ~
~
~ UNPAID BALAN~E
~ KlND OF UX TAX PERIOD ENDED /1SSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
: ~a~ ro~ <<~ ~d~ ce~
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' ~t o~?.~~ o~ab-~t 3~,~e.~s
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" F,jLED ~11p RECOA
; :T• IUCIE COUpTY f~
CLERKC
IRCI~ltT COURT ~
RFCORp VERIFIEO
'~~.r
~ ~ar 11 3 la PM'TS
~ :
~ -
~ •
,
; PLACE OF HUNG
- Y~= ~l~.
{ ~.o L16~ ~ TOTAL ; ~~~~9
F4 P1li~0it~ p~s :i~~E1
~
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~ WITNESS my hand ot Jackeonville, Florida , on ifiis, -
~
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~ 23rd of January 19 75
the ,
~ :
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~ SIGNATURE TITIE
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~ Jack Durant Chief S cial Procedures Staff
~ (NOTE: Certifica~e of o w ized by law fo toke ocknowledgm~ts is not esseotiol to Mie valid'Ay of Nolice of Fedsrd Toz lieo G.C.M.
~ 26119, C.B. 1950-51, 1. p
~ PART 3-To b~ used fo? ncordin~ P~+rposes ~00~ e~r ~V PA6F~l~
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