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Forth De~rtm9nt of ttN Tro•sury - IntKnal Ravnw S.tviCe
«~.,n~.;se, - Certificate of Release of Federal Tax Lien
District Serial Number 4 Fo? ootl•.w t/s• 0 PN 2
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~ I certify that as to the following-named taxpayer. the requirements of section 6325(x)
of the Internal Revenue Code have been satisfied for the taxes listed below and ~ t
for all statutory additions. Therefore. the lien provided by Code section 6321 for "
these taxes and additions has been released. The proper officer in the office
where the notice of internal revenue tax lien was filed on June 19 ,
19 7~. is authorized to note the books to show the release of this lien for
these taxes and additions. -
Name of Taxpayer
Residence .
]112 AIIrY!•
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assessment Identifying Number of Amt
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This certificate was prepared and signed at Jacksonville, Florida , on this,
the 28th day of February 0 '
Signature Title
Van E. O'Nea " ~ ief S ecial Procedures Staff
p'10tK Certificate of ollicer authorised by law to take acknowledgments is not sss•mitl to fh• .vapdity o/ Notk;e of
Federal Tax Lien O.C.IN. 284f9, 1950-t, C.B. 125.) ~/y~~~ s{~ Cik
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