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Form 6~ Department of the Treasury - Internet Revenw Service w ~ I ~i~y~.
~Rev.8eptemberiO;a, Certificate of Release of Federal Tax `Lien . ,V
District Serial Number For ovNotra/ thre ~ Rawordln9 olNw
1980 FE8 26 AN 4 2 ~
443838 B-308 P-1519
tIEQ A KECOdOf U
~ 1 certify that as to the falowing-named taxpayer. the requirements of section 6325(a) ~T. tUCI OL'HT Y. f L A.
of the Internal Revenue Code have been satisfied for the taxes listed below and RoGE~ POITRAS
for all statutory additions. Therefore. the lien provided by Code section 6321 for CEE°~+ Cl4CUIT CCti~~
these taxes and additions has been released. The proper officer in the office v£RiriEO_ _ ,~~,.-~g{
where the notice of internal revenue tax lien was filed on May 9 ,
~ 1979 . is authorized to note the books to show the release of this lien for 4~1~6
these taxes and additions.
Name of Taxpayer
~ • ~ ~1~
Residence
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assessment Identifying Number of Assessment
(a) (D) (c) (d) (e)
i
~ ~ ~
~ i
i
~ -
Place of Filing
~
Total i
This certificate was prepared and signed at Jacksonville, Florida , on this,
the 22nd day of F a ,19 80 -
Signature / Title e
O 800 ~ PACE
Van E . 0'
(NCte: Certificate o/ olficer authorized M law to take ecknowtedyments !s not essential to fhe validity of Notice of
Federal Tax Lien O.C.M. 2b~t9, 195x1, C.B. t25.)
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Part 3 . Tn M ncnA /nr rsaervtlinn tMlr[fOSAS Form 668 (Rev. g78)