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OEFApfMENT OF TIIE TfaEA31N1Y - YR~MI ~Yf/NE SdM11CE for Optional Use i~ ReC~adiny ONiOe
Ev- i~n CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN
DISTAICT SERIAL NUMBER
428197 B-300 P-576 C7V
1 hereby certify that ss to the following-named taxpayer the requirements of section
8325(x1. Intsmal Revenue Cods. have been satisfied with respect to the taxes enu-
merated bebw. together with all statutory additions provided by section 8321: and 1980 ~ I5 PN ~ 26
that the lien for such taxes and statutory additions has thereby been released. The
proper officer in the office where notice of internal revenue tax lien was filed on ~F,~E~1~ i~~Q~E
A.
December 21 1978 is hereby authorized to make notation t t. ~++T T~.r~
on the books to show the release of said lien. insofar as the lien relates to the folbw- 6LEft1I ONNRA~ ~ Q
i REt@R~ YERIFIEQ._.,._C~_____--T
NAME OF TAXPAYER ~ ~ ~ ~ ~ 483148
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RESIDENCE
f~
uNPaD sAwNCE
KIND OF TAX TAX f~ERiOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSIIAENT
tel (bl td (dl N?
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PLACI: OF FILING -
TOTALS
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WITNESS my hand at Jacksonville, Florida . on this.
the 9th day of ~Rril _ 19$0
SIGNATURE J TITLE
ief S ecial Procedures Staff
iNOTE: Certif~csts of officer sutfarasd by Isar to takes is is not •essantisl to the va4ditT of Notion of Federal Tea Lien G.C.M.
26419. C.B. 1950-1. 12 5.) r~
PART 5 - To bs used for recordirp purposef~0~ Vs.V P1~,lc