HomeMy WebLinkAbout0421 ~
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~ ~ U. S. TREASURY DEPARTMENT • n+TEew?~ ReveNUe sEevKE • fir Orr.o~rl Us~ a R~cdiM ONrn
; ' caev: a.b~~ CERTIfICATE OF ~EtEA~ OF FEDERAL TAX UEN f~~
~t.lUC1E GOJNTl? LA•
DISTRICT SERIAL NO. pOCE~ *81T~US
~T 1T022 OB 173 P 12 CIERK CinLU1T COUItT
1 h~reby certitr thot os to th~ iollowiny-nom~d toxpay~r th• r~quir~nwnts of S~etion afeo~n vf~+F1f0
~ 6325(0), Int~~noi Rev~nu~ Cod~, hov~ b~s~ sotisfi~d with respect to tl~~ toxes •nu- 1
~ meruted btlow, fogether with ol) stotutory odditions provid~d by Stction 6321; awd
! thot the li~n ~w such taxes ond stotutwy odditions hos tMrsby bee~ .~I~os~d. Th~
! prop~r o((ic~r in the o(fice wh~rs notics of int~rno) r~v~nw tox litn was filed 346458
Se~}t_ 6~ , 19~,_, is h~rsby authwized ~o mok~ notation
0o his books to ahow the rekoss of soid li~n, insofor os tF~s lien ~e(ot~s to fh~
followin9 to:es. ~
{ NAME OF TAXPAYER '
~1~ ~
RESIDENCE
~ 3~ liooc ~ ~
~ CLASS OF TAX UNPAID BALANCE
~ (Toa R~turn Form No.) PERIOD ENDED ASSESSMENT UATE lDENTIFYING NUMBER OF ASSESSMENT
I (c I (d ~
(o) (b)
~o~o t~-3~-6~7 oi-o3-~ zb~~-93~ 3St.t~
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PLACE OF FILING Cj~~~ CI$WIZ CA~Z
~ ~ TOTAL S ~1~
~f t~~ ~
4 .
WITNESS my hond at Jacksonville, F2orida ~~~,;s~
~}1e 22ad day of September ,19 ~6 . '
BOOK PA~ ~ `
SIGNA7 E TITLE '
aa ra t Chief S cial Procsdur~a 8taff
( T CNtiFicot~ oi officer outk+ai:~d br lo.+ to ta4e ocknowl~dym~MS is not ~ss~ntiol to t!r voliJiy ei No~ic~ d f~ixe) Tu Li~n G.CJi1.
3~ , C.B. 195451, 125.)
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