HomeMy WebLinkAbout2521 Form ~ OETART~A9tf Cf 1tE iElISt1RY~11[~tAl SilMICE For Opfiond ~ Ryoordr~ ONoe.
(REY. t ao) CER1iKA1E Of t~EtEAiE pi ~OBAL T~11~i1 .
DISTRICT _ sER~AI HuMBErt ~ ~#5i5,S17
->I herebtr certify that as b the folbwi~q~ogted rin nlquiretnards ~ Section
6325(a), Imenral Revenue Code, haw been sa~isat with reaped to tip. tuxes .m,.
mswted`;below, togdher with all stahdory adddiora~~pnovided by Ssdion 6321: aid ~ Zo ~ $
that ihs~lien for such taxes and shrtulory od~lions ha: thereby been releaed. The
P!'aPa b1° ~ where atkrnaf revenue fox lien was fled Qrt
19' . k herroby a;r~~..•i~d to make notation ,
on his books to show the release of said lien, insofar: as tM lien relates M the fdbw-
~ng foxes. _ - O VERIF r
! NAME: OF TAXPYIYER ~ Qa ~ xi
i
RESIDENCE - ~4~-'~
~ ~ sr...rr s~
~s~~, .
KIND OF Ti4X TAX PERIOD ENDED ASSESSMENT DATE IDENT1FlfING NUMBER OF ~I~SINENT
Ial rol kl ldl Iel
ti364•~
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i
PLACE OF FlUNG
C:1efk. Ck+ouR C01/t TOTAL =
I 8t L~ Coumq? ~
r
` WITNESS my hood of Jacksonville, Florida ~ on his,
- a~K314 P~E2514
the 6th day of AuQ , 19- 79
SK3NATURE / TITLE
Chief ~ S ecial Procedures Staff
(NOTE: Certificate of officer outhaiud btr law b acknowledpmenls is rwF essentid b the volid'Atr of Plolia of federd Tax Lien G.C.M.
26419, C.B. 1950-St, 125.) o j s
rare a-1~ b. tte.a ncondirt~ ~~e ~
_