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(REV. 1-70~ CBIT~IUTE O~ RELEASE OF FEDERAL TAX L~M FILEO ANU RECORDEO
DISTRICT Z18 P Z98Z ST. OCERCPJItRAS ~A.
: CLERK C~ :~Ut? COURT
1 hereby certify that os b the following-nomed~toxpayer the requiremeMs of Section RFrtlF;~ ~fPiF1Ep_.,...~,,,.~,
6325(a), Inbmal Revenue Cod'e, have been satisfied with respect to ths taxes enu' 1 12 PM 75 ~
mefated below, togeli~ with oll statutory add'fions provided by Section 6321; ond ~
that H~s lieo for such taxes and statutory additions hos thereby been releosed. The ~
• pro~~ in ths offxe whero notia~f inbrno) revenue tax lien wos filed on ~r~
, 19 , n hereby authorized to. make ootation ~t~
on his books ro show the release of said (ien, i~sofar as the lie~ relates b N~e fdlaw-
inp Mxat.
NAME OF UXPAY6t
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ao er?uwcE
KIND OF UX ~ UX PERIOD END~ ASSESSMENT DATE IDENT1FlfING NUMBBt OF ASSESSMENT
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; io~o ~a~oa~e ~t-~nt 9-~r~ o+~ os ee~u s~z.9o
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~ PLACE OF FIUNG
~ Q~clc t~4lt
~ ~ ~ ~ TOTAL ;
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~ WITNESS my hand ot Jackaomilla~ Florida , on this,
~
' the lat ~y ofApril , 19 75 ,
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~ SIGNATURE ~ TITLE
Jsck D ~~1Q~y~~ Chi~f, Spscial Procedura Stitt
(NOT . Cer icate of officer authorized by law to take acknowledgmenh is not essential tc the volidity of Notice of Federal Tox Lien G.C.M.
2 9, 1950-51, 125.) Q R ~Q
PART 3-To be used for recording purposes B~~ ~rtJt7 PA~E ~
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