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DISTWCT SERIAL NUMBER R00~~ ~'3;TRA~
1 Z98938 Bk 295 Paga 1027 ctEK+c c~ ~t-u.r cov~t
1 hereby ceriify thot as to the following-oomsd taxpayer the requiremenh of Section R i~ ne r o.,r ! E n.~.~
63T5(a), Interno~ ue ~ode, have~ satisfisd~
~ respect to the taxes enu- N~ 1213'N'75
marated below, t}x~ with al) statut additions ovided Section 6321; and ~
thot the lien for such roxes and statu?ory additiaa hos tF~eby been releosed. The
pro~ P~ice where notice inierncl revenue tax lien wos filed on ~~~p~.~C
, 19 ~s, is hereby authorized fo moke notation ~~V•7Va7J
on his books-to show the releose of said lien, insofor as the lien relates to the follow-
ing taxes. ,
NAME OF UXPAYER
~ut.~c.~cs z. a ,~as~cs ~ ~
RESIDENCE ~
!.0• D0~ IaOQt
- UNPAID BALANCE
K1ND OF TAX T/1X PERIO~ ENDED ASSESSAAENT DATE IDENTtFYING NUMBHt OF ASSESSMENT
ial (b1 kl (dl (e)
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~ PIACE OF FIUNG • :
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TOTAL s ,i~~~ #
fort Plert~. Fbrkls
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~ WITNESS my hand at Ja~~~~i 11~Tplos~da • , on this,
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the 23 doy of ~Y , 19 ~S ~
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~ SIGNATUR T1TLE
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Pi`: `
~ _ k Dur Chief, Special Proc~durea Staff
~ ~NOTE: Ceriificote of oR'icer outhorized by law to toke acknowlalgments is not esserdid to ths volidiryr of NoFice of Fedard Tmc Lie G.C.M
26419, C.B. 1950-S1, 125.) ~t 4
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~ PART 3--To b~ us~d for nwr~n~ purpos~s
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