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Form ~QQ.• Department of the Treasury -internal Revenue Service 4 I Vr'~IA~\
(Rev. septemt)ar 197$) Cer#ificate of Release of Federal -Taxi Lien ~ ~7~~
District ~ SeNal Number Fp Optional lIs• by R•cadlny ONice
X80 f E8 22 :111' ~ ~
455510 B-314 P-2507
1 certify that as to the following-named taxpayer, the requirements of section 6325(a) ~ u RECQRijE
f~the Internal Revenue Code have been satisfied for the taxes listed below and ~~Tj~T
al s atutory addttions. Therefore. the lien Provided by Code section 6321 for
these taxes and additions has been released. The proper officer In the office p~VERiF{EO~-~-~------
where the notice of internal revenue tax Iles was filed on AuQUSt 20 ,
19~_, is authorized to note the books to show the release of this lien for
these taxes and additions. 4~~
Name of Taxpayer _
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Residence
22D~! vp1Aa l~'at 81~s
~ Kind of Tax Tax Petriod Ended ifla Assessment Iden Unpaid Balance
tifying Number of Assessment
1 la1 lb) lcI IN l•)
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Place of Filing
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e~. iadi ools~ airl>tlti~eus~ Totals ~6~.?s .
. Ftoa~o~, lLi. 33~
This certificate was prepared and signed at Jacksonville, Florida . on this.
~y ~ Feb ,19 80
Signature ~ T"dle
Van E . 0' Y'`"~
p' Chief, Special Procedures Staff
ttrotec crttricar. a onicer .urnwrz•a by law ro tak• aeknowl•dpmsMS to n ial ro rn• va?idlry W Notlc• a
F•Aaral Tar U•n O.C.M..2(FI1o, 10.Sa/, C.B. 12b.)
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