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Form OH/1RT~AFM Of it# 1RFASlJRr-.Ri16~NA1 REVBrUE SLICE For Opfiond lM y Reo~^8
f (REV. 1-70) C8tTE1CATE OF RBE~SE01~ ~DQAL TAX f~l~! .
DISTR,~T seuA~ NUMBNt 4'77168
261305 b-217 -1482
I hereby certify that as to the folbwing-nomad taxQayer the requirements of Section
f 6325(0). Internal Revenue code, hove been satisfied with respect to the taxes enu- ~~0 FE6 26 ~ ~ 1
~ meroted bebw, together with all statutory additions provided by Section 6321; and FI EO Atlp PEC011u%0
that the I'~en for such taxes and statutory additions has thereby been released. The ST~UCIE COUttTY.FIA.
proper officer in the o q where notroe 9 mternol revenue tax lien was filed on ROGER POITRAS
i August l~th _ , 19 / ~ , is hen3by authorized to. make notation a.ERK CIitCWT CO
on his books to show the release of said lien, insofar as the lien relates to the folbw- RECOt10 YERtFIC~
ing taxes.
~ NAME OF TAXPAYER
i
4'77168
s RE51 E
~ 'i0lf~ 12~ ~t
j UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IDENTIFYING NUMBER OF ASSESSMENT
lal Ib) k) ldl le)
~ i
1010 ~ooelt 1~3i-T2 06~-173 264 ib ~ i 3,~.f~4
I
i
~ i PLACE OF FILING
Clll[s ~ C0~'~ TOTAL = ~
=il~i
WITNESS my hand at T ck snnvi 1 1 p F1 nri rl ^ , on this,
the 21st day of FebrLa 19 °O
SIGNATURE ~ TITLE
~ i.'
(NOTE: Certificate of otTxet aitl?oriz by low to take Ied9menls a not essenfi to the validity of Notite of Federd Tax Lien G.CM
26419, C.B. 1950-51, 125.) ~
P~QT 3-Te tae used f~er neordina ourooses tltlf>I~ P~