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i form 658 oer~uT?,~rir oF n~ ~tisurr-~w~e~uu eEVtNUe 5~ancE Fo. Oa;onol Use er Recordrg O~Ra
I ~rt~v 1.70~ . ~ C~tTiFIGYF Of I~LEASE Of i~DpGl TAX UEN
DlSTRICT - SER1Al NUMBER
t~,~ 210621 b193 p433
1 hereby`ce»ify thet os to the following-nomed toxpayet 1he requiremenss of Section
6325~a). Internai Revenue ~ode, hove been satisfied with respect b the taxes enu- ~ ~
' meroted below, together with oll stotutory edditions provided by Section 6321; and ~F~ . ~1~ '~'e`~~~~"
that the lien fa such taxes ond siafi~tory addihons hos thereby been releosed. The
~ properaffjc~,r in the of~ice where notice.qf interna) revenue tax lien wos filed on
JuA 14 ~ 9 i i,~~~r outhorized to r?tiake notation
I on his books b show the release of soid lien, insofar•~ the lien relotes to the toiiow- • .
I ing taxes.
N/1ME OF UXPAYER ~ i
~f Iw.iry ~hr. -
RESIOENCE
a
~e
UNPAID BALANCE
K1N0 OF TAX TAX PERIOD END~ ASSESSMENT DATE IDENTI~YING NUMBER OF ~SSESSMENT
f°1 lbl kl IdI (e) -
~ ~ v']~-6T 5-17~ . ~-?1~-+~43~ ~]3.2T
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( rucE oF Fiur~c .
a~s C.~e~t Cwrt 3]3.2T
st. L.osr. c~ ,or~~" s
M~es~, l3~arl~a
WtiNESS mr hand at Jacksonville, Florida , on N,~s,
~e 3rd ~ of Novembez ~y 76 -
' BGOx fAGE
s~~w?TURE nnE
Jack Duraat Chief, Specisl Procedares Staff
~ (NOTE: Cart~cde outhorized by low to toke ocicnowledgmenls a nW sseMid to Ih~ volidiRy of Notice of federd Tm~ lier~ G.C.M.
26419, C.B. 1950 , 125.) ~
ae
PART 3-To bt us~d fo~ nsordina p~rrpos~s ~
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