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I Fq~rn 668 , oEr~u[r~t~7 oP ~E nFwsun-MH~ ~EVE~E seMCe } - ror op~o~wt: tb~ M R.oo?drg olRoe
i tR~. ~ o-» ) 'ZBtT~ICATE ~OF REIEASE.Of fEOBAI TAX ~1 ` ~
~ DISTR(CT .~,'1i~Ni.l.R ~ SERIAL NUMBER i•= , ~
_ 299814 B?35,_P?140 `
~ = i hereby certify that as b the folbwing-oan~d Mx~ba~ref the requirements of Section ' w
; b325(o), Intemal Revenue Code, have been `satisfied with respect to :the taxes ~enu . p ;
' merated'belovr, togetherwith a0 statutqry adddion~;Pro~ded~r Sedion 6321; bnd _ ' ~ •
; fhor ths l~en for wch taxes and sratutc~ey ad~ion~~hos thereby been releosed. fi~e ~ ~i/'~ '
; proper of~icer in the ofi'xe wfiere natiq~ of=°niternal revenue tax lieh was filed~oe - ;
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: a7anuszg 22 , 19'75
'.'is hereby auihoriud to Niaks notdion . .
ot~ his books to show the ~eleose of said lien.° irisofar as the (ien relates to the Iollow-
ing imces. - - _ . .
NAME OF TAXHP?YER . <
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' RESI CE ` . .
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. • _ " ' UNPAI~ BAIANCE `
KIND OF UU( TAX PERIOD ENDED DATE OF ASSESSMENt IDENTIFYING NUMBHt OF ASSESSMENT ~
f (al (~1 kl Idl (el ~
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a PIACE OF FIUNG •
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~ ~R'~ PI~E.r f#ARIOA TOTAL S 1l~+~ a
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~ WITNE55 my hand at Jacksonville, Florida , on this,
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~ the 12th ~y of February , 19 75 .
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~ SIGNATURE '
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~ Jack D~rant Chief, S ecial Procedures Staff ~
(NOTE: Ce~cole of ofFica out by law ro toke ocknowledgments is not essentiol to the volidiry of Notiu of Faderd Taoc Lien G.C.M.
~ 26419. C.B. 1950-S1, 125.)
~ PART 3-To be used for recordin~ pvrposos 6~~ P~f ~1~?
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