HomeMy WebLinkAbout0295 . ~
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For~f 86Y OEN1/?IIEM? Of THE T/EAtU~II-IMIE~IU1l *EVENUE fE ` FO/ ~GOrta/ Ilss 8y R~eoldin~ 0/HOI -
tRev. ~3a4f CERTIfICATE OF RELEASE OF FEOERAL TAX LIEN
013fi IC ; • RIqL B , . ~i -
1~ 247 l~G t614 ~ : _ ' : .
! her~y artify that ss to the folbwing~nanNd Uxpiy~r th~ rpuiraments of Ssction .«r ,
632bta). Internu Revenw C.ah, haw b~n qtisfi~d with rsspa~t to th~ taxes u~u-
m.r.nd b~ow, to~ect~ w~th d~ st,c~ton? aaa~tion~ p~wrid.a a,? section saz~; snd ~ _
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d~at ths lie~ fo~ such taxss md statutory sdditions hss thwaby be~n relMS~d. TM - ~ .
prop~r offiaer ie ti~e offica when ~otios of int~rnal rwenu~ nx lim was filed on .
~~YatT Z1 4 . 19~..? is iNreby authorizd to mske notation , -
on his book: to.sFww tfie relsns of s~id lie~. insofar ss ttw lien retstes to ths follow-
i tax • 4 . ~ F
NAME OF TAXPAYER ' ~
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RESiQENC~ ~ ~ _
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UNPAtD BALANCE
KIN~ OP tAX T/1X PERWO ENDE~ DATE OF ASSESSIMENT IDENTIFYING MUMBER OF ASSESS~AENT - -
b1 tbl tci Idl t~l `
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PIACE OF FILfNG .
~ ~ TOTAL S T~~~
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VYITNESS my hsnd st , Jaak~oavill~. ~~ida , on this,
tfi~~_dsy of Jl~~._, 19
. d00K PACE #
SI6NATURE TITLE
Jiatt Durao~ Q~i~~ Sps~tal h~oc~dur~a Slai!
• (NOTE: W of offiwr wU+o~iz~d by law to uk~ ~elcnoMA~dprNna b eat ~w~neial to tlw vNldity of Notfw of F~dr.d Tas Li~n O.C.M.
20~t~, .Q./ 1.120.1 ~
PART 3- To b~ us~d fo? r~cardin~ purposss ~
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