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; p~~ ~ ll. S. TREASURY DEPARTMENT - aTEaM.~~ REr~t~uE SERV~CE Fe. qrao~.l us. ~ R.c.a~ OH+c.
` taev. a.~:~ CERTIFICATE OF REIEASE OF fE~ERAI TAX l1EN
~ DISTRICT SERIAL HO.
~ 167922 O.R. Book 172 Pa e 896 ~~a11TftA.
! I h~r~br cer1iiy thot os to th~ iollowiny-nomed taxpoy~r th~ raquir~msnts of $~ction
~ 6325(0), Int~rnal Rev~nue Code, Fwvs been sotisfied wi~h r~spect to tF~~ tox~s ~n~- "£f'~ ~~'~~T
1 m~roted below, togerher with oll statuto~y odditions provid~d by S~ction lS321; ond wfCOP.9 Y[Ri~fES a
, that th~ lien io? such tox~s and staturwy additions has ther~br been r~leosed. Th~ ~3 ~ ~qr
proper of(ic~~ in ths olfics wher~ ~otics of interno! rev~nue tox iisn wos fil~d on ~p
~ June I2. 1968 ,~q is h~rebY authui:~d to mok~ nototion . ~ ~ -
; on his books to show the reltase of soid li~n, insoFor oi th~ lien r~lotes to•ths
(ollqwin9 toxss.
NAME OF TAXPAYER V
RESIDENCE
i ' ~
~ C~A55 OF Ux UNPAID BALANCE
~ (Tox R~turn Fwm No.) PERIOD ENOED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSliAENT
(01 (b ) (c ) (d ) )
~
~ 9r43 ~/b7 ~/S~/~ S46i~S~~?7 ad6.C~1
; -
;
;
i
; -
~
PIACE OF FtUNG Ci~iL C~~"~
st~ ~ TOTAL S
' la~art n.~.., tlosrsd. .
INITNESS my hand at Jacl~on~•ill e~ PL , on this,
the~4-doy of Sept. ,19 76 ~~a- ~~Q~~-~__~~
SIGNATURE TITLE ~
, pCK RANT CHIEF SPECIAL PROCP.DURES STAFF ;
(NOTE: CertiFicot~ of o~f r o~thori:~d by low to tok~ ockrw.f~dqm~ms ~s not ~ss~n~iol to ~M .alidity of NWic~ d F~d~rel Tm Li~n G.CiI. ~
26119, G.B. 1950~51, 125.) '
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