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{ ~R~v_ z-»? • CERTIFICATE OF RELEASE ~ FEDERA~ TAX LIEN rrn ~r~~s
( OISTR CT SERIAI NUM,~ER T AO~C R P~-
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t
y th8t ss to the idlowing-named texpeyer the requiraments of section ~F~?IiIED~
` 63Z6(s). Intemsl Revenue Code, hav~e been satis~+ed with respect to tt~e taxes enu-
f inerated be~ow, together with a~~ statutory add~tions provided by section 632 t: and KAY Z IO 31 QH ~
~ that the lien for such tsxes and statutory edditions haa thereby been releasod. The
-~ugue t- 3 ~~~°8 ~re notiC~ of internal revenue tax lien was fited on
19 ~ . is hereby authorized to make notation
on ths books to show tAe rebase oi said lien, i~sofar as the lie~ relates to the folbw-
i taxes.
NAME OF TAXPAYER
! ~a~~~~
RESIDENCE ~ ~ ~
~ ~
UNPAlD BALANCE
KIND Of TAX TAX PERIOD ENDE~ OATE OF ASSESSMENT IDENTIFYING NUMOER OF ASSESSMENT
Is1 lbl Icl Id) le)
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PIACE OF FIIING ~ ~ ~
~ TOTAL S ~j~
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WITNESS my hand at Jacksonville, Plorida ' , on chis,
t~24th day of Apri1 19 78
SIGNATURE ~ TITIE
~
Van E. 0'Neal tin Chief S cial procedurea Staff
(NOTE Ceraf~wta ol oH~cer autho~aed by Iaw to tske ackrwwledgmsnts ~s rat essenusl to the val~ty of Nouos of Fedsnl Tar l+sn G.C.M.
264I4. C.B. 195G- l. 1251 ~
PART 6- To bs used for rscordi ~
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