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Fp~ ~ OH~1RfAAEt~ff Of TME i~EAA~f-NTE~IiAI lEVN~{UE SElV1CE For Opti0wol lb~ Ap R~ool~6np OR'ic+
; ~~v ~ao~ ~ t~itAT~ OF RBEASE QF ~D~AL TAX t~! ~~~uc~cou~ r~Ee
' o~sracT s~ t~tset ~ocE n ?orr~a ~
11~ ~ CLERK ClkCWT COURt W
1 hereby oertify that.cs to the following~nomsd tuxpoysr the roquirements o Saction RtCeR~ YERiriFO
6325(0~ InFemal Rev~enue Code, have bsen wfisfied with resped-to the toxes enu- V
msroted below, togeti~ with all stotutory add'fions provided by Section 63Z1; and u~ ~
tF~ot ihe (ien for wch Mxes and srotutory od~tiora has tlbre6y been released. The ~~e ~ ss P~1 T~
proper oMioer in the o1F'ioe where notios of iMernol re+ronue tax lien was Flsd on • A
, 19~_, is herebp authorized to moke norotion O
~ h~ ro the rolease of said lisn, insofar es the tien relares ro ths fdlow~- ~QO .
P1MAE OF T/1XP~+?Y9t
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! qND OF UX UX PERfOD END~ ASSESSI+AENT DATE IDBNTIFlfING NUMB9t OF ASSE'SSMENT
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lOi4 1l-~3-Z! O~-!?-T! ~l0-~-0~81 ~li.0~ -
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~ PLACE OF FIUNG .~~~t Cw=„i
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~ WITNESS my hand at JAckaonvf 1~ e, F1 ~ri ~A , on this,
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~ the~~.day of ~~1~-. ~9 7S
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~ SIGNATURE n T1TLE
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~ ~NOTE: Certificate of Ker oulhorized by law to toke ockrawledgmenfs is not esser.tiol to the validity of Notice of federal Tox lien G.C.M.
~ 26419, C.B. 1950-51, 125.) Pl~ ~l.r~ hds
PART 3--To be usad for reconlin~
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