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• FO~ V~~ O~p~nnint ol tM Tn~wry- MRMnM A~w~w 8~viw
(Rw Sepsirt~bu 1078) Cert~icate of Release of Federai Tax Lien
OisMct Serial Number ~ Fo. opt~a,.~ us. a? R.ao.m~w o~ac.
1s~~I1! 437280 BK305 Pg226
i certify that as to the followin~-named taxpaye~. the requirements of sectjon 6325{a)
of the Intema! Revenue Code have been aatisfied for the taxes listed bobw and
for all statutory additiona. Therefore. the lier? provided by Code section 8321 fa~
these taxes and aclditions has been released. The proper otfioer in the office ~ED ~,t: ~ RECORDED
where the notice of intemal revenue tax lien was filed on March 1 S . ;.'J C:-- U ~i T Y. = t-
j 19~~.. is authorized to note the books to slww the release of this lie+n for ; ~ F~ F
ihes8 tauces and additions. - ~v~~r .
~ Name of Taxpa
~ k~r!' Q . ~7~ ~I OQ ~ 7 PM 3 2
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Residence . , , 4I
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; Kind of Tax Tax Period Ended Oste of Assessment identiryrirq Numbsr of Assessnfent ~
!e) . (D) [e) [d) [~l
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~ 1040 lt-~ 1 ~ i6~O~l~•(t~~ ~ ~
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~ Place of Fiting ;
01~~t ~f tt1~111~ ~~e~ '
' it. Lwi• o~~ C~~a~tl~.~ts• Tota~ t i,S9s• 9R
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This certificate was prepared and signed at Jacksonv i l ie, F 1 or i da m~s~
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s the 4 ~y of Apri 1 79
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; Signature ~ Titie
~ Chief S eciat Procedures Staff
Van E. 0' Nea ~ I~ . P
Mar. co.r~?c~r~ o? onk.~ a nw~:ed oy aw ak~ ecknowr.d~mena ts not «s.m;d to rn. va~wiry a xQtrc~ a
F.d.n, Tu U.r, a.C.A1. ~6~,0. ,~54,. C.B. ,~5, ~I~~ R~r~t ~ i5 AC
= Part 3- To be used for recording PI~~~Itk~ ~ Fofm 868 (Rev. 5-78) i
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