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; ~g , oc~cr~xr oF it+E n~wsuer~K ~va~ sanncE rw opr~ u~. er t.~or~~ orFo.
(~r. taol CQINCATE Of RB~ASE~f f~D~At TAX tl~1
asrwcr . ' se~ NuMer~t g~
23T665 Bl~ PO- wo~~am ~~Y ~I~~s ,
~ 1 herobr osrtiEy thot as to the. fdbwing~named roxpo~ ths roquirements of Section ~~:i u tI C o:, k
6325(0}, Interrwl Rev~ue Code, hove bea~ ~isfisd with respsct to the tdces e~w?~ - -
! meroted belo~w with cll odfirtions ovided b Section 6321; and t pu ~
; thct ths lien for wch~taoces and statu~ory addilioos h~aa tl~eby bssn roleosed. Ths Z~ i Z 4 S! f~
, proper ~ offios ratia~ mbrnd rav~snus taoc lisn wm f,led on
~ 19 rl it hsrsby ovllwrized to make notation 41~ ~ 1.~
on i~s boob ro show fhs relsose of soid lien, insofor as the (ien rolafes ro fhe follow~ _
i~g fa~oes.
NANIE OF 'UXP1~1Y6t
~
~ RE.qDQ~lCE -
~ SDli2 ~
M
UNPAID BALANCE
KIND OF TAX TAX PERIOD END~ ASSESSNIENT DATE IDBJI'IFlfING NUMB~ OF ASSESSMENT
~ Ial ro1 ~ t~l Id! ' Ie)
1G40 It~p 3~-3I-69 04-2s-?2 QIO Q? b.."79 S 2,7'1.^.C6
i
PtACE OF RUNG
+t'1iI~C~ C~3"Ci~i~ TOTAL S ?,.~TI?+C~
Sl.. Lqci~ ~sitY -
W17NESS my hand ot d~CIC~Omrille~ P'1.a1'ida , on this,
?f,~ 5 daY of J~ , ~ 9 78
SIGNATURE TITLE
Fraak L. Johna Act Qiiet cial dure
(NOiE: Certificde of ol~icer outhoraed by law to take ockr?owfedgmenh is not essentid to the validity of Nolica of Fe~erol Tox lien G.C.M.
26~14, C.B. 1950-S1, 125.} 8~~ t30
PART 3-To be used for retordinQ purposes
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