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Foemad8 - OffAIlilAfltt OF 11i iNfASIMY - IIEYEIwE fo? Optional Use By Raeading OHips
IREV. s-»t CERT~ICATE OF RELEASE OF FEDERAL TAX LIEN
j pl~~R I,_C_T~__~,~~• SERIAL NUMBER - •
)w~wlt~t[ 399760 B-285 P-30 LED sNt~ + •...::+t?E
' I hereby certify that as to the following-named taxpayer the requirements of section LUCIE ti _ FL~.
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63251x1. IMemal Revenue Code. have been satisfied with respect to the taxes enu- qOG? - ;,S
merated below. together with all statutory additions provided by section 6321: arM CLEF!..~•.~~•-. 0
that the lien for such taxes and statutory additions has thereby been released. The RECOe~• : ' =
proper o tD the office where noti of internal revenue tax lien was filed on
i I AP rT 1 i 2 19 7~ is hereby authorized to make notation ~ t ~ 2 20 PM
~ on the books to show the release of said lien. insofar as the lien relates to the folbw-
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I ~ NAME OF TAXPAYER
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~ ~ ~ ~ ~ i. i~tiit
~ ~ REST ENCE -
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UNPAID BALANCE
` KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
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a I PLACE OF FILING ~ .
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WITNESS my hand at Jaci;sonville, Florida on this,
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the 3rd day of llec~mhcr tg 79
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SIGNATURE TITLE
1
Van i:. U'Ztical ~ Chief, S ecial Proced~?res Staff
(NOTE GrtA~cate of oH~cer aut aed ay law to a scknorvlsdgments ~s not essent~sl to tM vshdity of NoUOe of Federal Tu lun G.C.M.