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Form 6 OE~MTYENT OF THE TNE1WlNY-INTERIfAI tEVEMUE SEMCE FOr ~tiOrls/ (/se 8Y RICb/diny
(REV. 13-~a) _ CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN
DI TRIC SE IAL NUMBE ~
. 2 P2 l - 4
1 hereby certify that as to the following-named taxpayer the requirements of Section
6325(al, Internal Revenue Code, have .been satisfied• with respect to the taxes enu-
merated- below, together with all statutory' additions provided by Section 6321; and
i that the lien fot wch taxes and statutory additions has thereby been released:--The 4~
proper officer iq the office where notice of internal revenue tax lien was filed on
_iune 22nd 191(L., "is hereby authorized to make notation
on his books to show the release of said lien, insofar as the lien relates to the follow-
i taxes.
NAME O TAXPAYER ~ A~ ~1 PM i+ 03
t. ~p ao~t
RESIDENCE
2L ~ ~ +~rvtlel~
UNPAID BALANCE
~ KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYMIG NUMBER OF ASSESSMENT
f (sl Ibl lcl Idl lel
.2140 1~1`-7~t - • 159.t!
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! ' 1
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n
PLACE OF FILING ~ ~
i ~ TOTAL S ~2!
~i• l~rt
K WITNESS my hand at Jacksonville, Florida ~ , on this,
the~,Ztllday of April 19 78
SIGNATU E TITLE
~
0' eel Actin Chief S cial Procedures Staff
(NOTE: Cartitiuta of olfioar authorized by law to take acknowladgmants is not asMntial [o tM validity or Notiq of FadarM Tax Lion Q.C.M.
T6~19, C.B. 19641, 7T5.) • r"
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