Loading...
HomeMy WebLinkAbout0071 ' . 4 ~ _ t i . . . ' _ _ . _ _ . r . _ . . . ~ _ . . _ . _ „ ~:1~. S. TREAS~tY ,DEPARTMENT - 1l~tEbu?L 11E11EwE iERrKE . ~ fr 4~•+~ IA~ 1r Rrcri'+~ dI'~tt ~ - tR~r.~K» ~rt~CA~f~Oi lEt~ASE Of~i~ERAI TAI-L~M ~ . . - DIST T. . _ : - ~ SERtAI ` 7 27~,5 ' ' ° ; ° ci~ '4t~$ ' ~+l~ _ . ~ ~ ~ . ~ b.tA~? e«+:I~ ~.t,M h f4.~felle~?Mgeaa~s.=..r.._ M. »,Yi...a~ts oi s.ct~,.ipn . . ~~+NC~aoW~ ~etl?T ° ~i 6~tS(e1..1n»reol R~w,iw Coi~. law s~Ri~ft~i#at~b r.sMc?. to ~b. ~.s .nti• vER1iiE0 s~roh~i~lrw. teq~1M* ~rhl? ~11>,s1+~v~qy_ odt~ia~sr~rid~ S~ct~aw b~'2tj ~ " fhi,t tl~.-N~., i« ~eeh i~:...1~ .t~+uto.,f ~i.: fb:s.ih, j.«~ hf~esar. n~: . •;~p-9 µ gM tM ~Yiiu +rlw~~ .w~ti iwt~.Mf nwe~ t~t Ihw; vr~s ii W~a~ - ' s~' ~u , l - 1~~ ~ I~.~,i~r .~tl?.rts.~ a..l~ ~ee.ti`.` : Y. . ` ar. his- i~1cs h~ar tM nlws~. ef s~id I~ie. iesel~ ~s tlr ti~w nMks t~ ~ i -~y' ~ - t~lMw ~~iox~s. ° - r_~. _ ,,4. . ~ ' . Ii~ME ~F TAXP#YER ~ . - " • > ; ~~~~a - ~ ~11~~ ? ~ - ~ ~ ~ - ~ . RESIOEqCE . - ~ ` ? ~ . = ' - j.c., . ~ ~ ~ _ - . . . - - , . u. _ . . . - _ Y_ . . . ; . i . J . . _ ~ ~ ~ = . , CL115i =TAX ' ; . , ~ :_-F . ~ s - ~ . . i ~ "~:BI?~-~l1/GE (Tex RNww F~.Ne.) P~R{d0 ENDEO ASSESSMENt DA~E- 1DENTIEYINfr NiJYBER _ ; OP ASS~SSMENT ~ k! W) t~) 3~ ~ ~ - I i ~ - - - . ~ - ~ - ~ , ~ - _ ~ - ~ . R ' s • ~ , ~ i 4 ? s , i . ; ~ , t ~ { - _ a y,~ 4r , ~ PLACE OF FILIHG ~ Q~i ~~t TQ'~AL s ~ . ' ' . WITNESS a~y hand ot Jacksomtille, Flosi da oe ihis,. ~ • a tfi~ 6 doy of Septeaber ~ jq 77 ~ - ~ IGNATURE TITIE ~ ~ : Chisf 8 cial Procedures Staf! ? ~ d10TE: G?Nf eM wrirt:~d ?p Is te ~ab «kwwl~ars is w~ ~saa~i~l te ~M .ol~tryr ~f N~Nc~ ~f Fed«el Tm~ LiM G.CJA. • ; ~w,c.s. . ~~s.t -dhb . ~ ~ ~ART 3--To b~ w~d fw nc~rdin~ pu~pes~~ :