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~ IREa/. z-n? 'CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN
j DISTRICT ' SERIAL NUMBER
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~ 1 hereby Certify that as to the following-named taxpayer the requirements of section >l~. lUC1E ; r FLA.
8s2b(s). Intsmal Revenue Code. have bean satisfied with respect to the taxes enu- ROCE~ '~eS
metaled below. together with all statutory additions provided by section 6321: and CLERr. : _ , ' : UR
RECOar• :i~•I:t
that the lien for such taxes and statutory additions has thereby been released The
proper officer in the office where notice of internal revenue tax tier was filed on
~ necetnher t q 1g~Z_. is hereby authorized to make notation 1~ ~ ~ ~ ~,q
on the books to show the release of said lien, insofar as the lien rotates to the follow-
NAME OF TAXPAYER ~ R~1"f'li~ '
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UNPAID BALANCE
f i KIND OF TAX TAX PERIOD ENDED GATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
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1 PLACE OF FILING
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WITNESS my hand at Jacksonville, Florida on this,
the 30th day of November ~g 79
SIGNATURE 1 TITLE
Van F,. O'Nea ~ ~ ~ P Chief, Special Procedures Staf~'
(NOTE Csruf~cats of oH~cer sut r~zgd try Law to is ckrwwledgments ~s not essent~sl to tAS vabdrty of Noaoa of fta0sral Ts: l~ G.C.M.