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Fwm 6AB OE?AIITIffM10F ~ME TI1EAfU~Y-INTERMAI ~EVEMYEtf11WtE For ~tionil l/m By RrCOMiny O~INae
ta~v,.~z-~~~ ~ CERTIFICA?E OF RELEASE OE PZOERRi. TAX LIEN
1( a Y FIA.
D1 T I SE~RIA NUMB R ~R00 R i~pt S
- 351978 bk260 2 ~tf~oa~y~Mf~EO
I hereby certify thst ss to the foilowirq-nsmed uxpayer the rscjuirements of Section ~
63251a1. Internsl Revanue Code, have bae~ sstisii~d with respsct to the taxes erw- ~ I( `O ~~Y ~?7
rr~ated bMow, toysther with sll statutory additions provided by S~:tion 63Z1; and w~ .
that ths lien for such tsxes ar?d statutory additiora has thereby been rel~asad. The
~ proper officer in the offioe where notioe of intenul ~evenue tax lien wss filed on
~ _ DeCember 8 , 19 .7~. is Mraby authorized to m:ke notation
~ on his books to show the release of sa;d lien, insofsr as the lien relates to the follow• 'c~~A~q _
; i taxes. tiv ~IrrV
~ NAME OF TAXPAYER -
' r~ # i n? s twusa 359923
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~ ~tES10ENCE
~ 72! • ~ 'lL! ilswt
~ l~iet~ 3~l27
} ' UNPAIO BAIANCE
i KIMO OF TAX TAX PERIOD ENOEO OATE OF ASSESSMENT IDEN7IFYING NUMBER OF ASSES.SMENT
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i PLACE OF FILING CL~~ Cj~YIt ~
. K TOTAL S ~~•i~
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WITNESS my hand at Jacksonvil le, Florida , on this,
me 25thday of February , 19 77 ~
F~ LI ~
SIGNATURE E
Jack Durant Chief, S ecial Procedures Staff
(NOTE: C~.titiut~ ot offic~r th by law to tak~ ~cknowNd~n»nts Is not ~ntNl to tfN vdidity o~ Nodd of FWbM Tas Li~n G.C.M.
Z64/9. C.9. 1~50-1, 1~5.1
- PART 3- To be used for recording purposes
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