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FonKl ~ - Department of the Treasury - Itttelnal Revetwe Service
` 4bi3146
tR.,, ~eA1~,o78, ~ certificate of Release of Federal Tax Lien
District Serial Number Fo. o/,eewnl we br R.~orolrw onr~e •
~s
Jit~~ 455508 BK 314 PG 2505
I certiy that as to the following-named taxpayer. the requirements of section 6325(a)
of the tntemal Revenue Code have been satisfied for the taxes listed below and
for all statutory additions. Therefore. the ties prarided by Code section 6321 for ~M YERtF~O
these taxes and additions has been released. The proper . officer in the office
where the notice of internal revenue tax lien was filed on ,p,t~~ys ~ 20 ,
19~g_. is authorized to note the books to show the release of this lien for ~Sa~~.
these taxes and additions.
Name of Taxpayer
~9¦lh T•
Residence .
ra. ~ ~
r~. rs.e..r sLw ~
Unpaid Balance
Kind a# Tax Tax Period Ended iJate o(f Assessment Identifyitty Number of Assessment _
~ (a) lb) (c) ld)
i
lrit a~~ ~~~b
E
E i
f
I
4 .
i Place of Filing
~
1ir1~ ~m~ tDl~l~l~wtr~ Total i ~~3.~1
!'ire ~3is
This certificate was prepared and signed at .iACKSONVILLE, FLORIDA , on this,
the 10 daY of Apri 1 ,19 80
Signature ~ Title
VAN E. 0' Ci~/ ~ CHIEF, SPECIAL PROCEDURES STAFF dj
Motor Grtifiute o1 oHieer authorized by to tales acknowledgments fs not essential to tha ralioity of Notice of
Federal Ta: Uen O.C.M. 28~1g, 1950.1, C.B. 125.)
at1aK~ PAGE~`](j~ TO . BE_ USED FOR RECORDING PURPOSES
J~ j, P~ Form 668 (Rev. X78)