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Fwm 66~t OE?APiYENT OF TME TpEASUNY-INTEIINAL 11EVENUE SERVIGE FO/ fJp[+Ons~ Vse t7y HacorO~ng ~Jiitcs
caEV. ~2-ia~ CERTIfiCATE Of RELEASE OF fEDERAL TAX UEN
' SERIAL NUMBER
- /_~lE0 ~Rp R~CpAQEo
iT. ~1lCIE CObMT~ llA.
1 hefeby certify that as to the fotlowing-named taxpayer the requirements of Section ~~OCEA Pp1TAA~ ?
6325(a?, Internal Revenue Code, have been satisfied with respect to the taxes enu- IIECORp YEAIFtEp C~RT ~ 1
merated below, together with all statutory additions provided by Section 6321; and
that the lien for such taxes and statutory additions has thereby been released. The ~~'g ~i
proper officer i~1 the office where notice f internal revenue tax lien was fited on 1(~
J~~1"Y y , 19 ~6 is hereby authorized to make notation
on his books to show the release of said lien, insofar as the lien relates to the follow- ~
i taxes.
~ ~O.F TA~XPA~YER ~~~?~r
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UNPAIO BALANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
i lal Ib! (c? Id) le)
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~1A 1Z-3h7'~ 1l-a-7S 5~-1P~!'~T~ l~490.4~?
9~ ti~-jl-T~t 1l-4-?S ~+1!!!?~ 5+6.1~1
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WITNESS my hand at Jacksonville~ Florida , on this,
the27th day of ~y , t9 76
f~
SIGNATURE TITLE
a Chief, Special Procedures Staff
(NOTE: Certii~cat~ 01 ~r authorirW by law to tak~ scknowlWyrr»nts is not ~ss~ntial to th~ validity o1 Notic~ of Fsdersl Tax li~n G.C.M.
2W19, C.B. 1950-1, 125.) -
~ g PART 3- To be used (or recording purposes
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