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Form WpBtte~nt Of H1rr Tnrawry- kN~rml q~?BiNa• afatl1lCfa ~ _ ,
(Rrav s.a.wb.r,BTa, Csrtif~ccate of Release of Federal Tax lien
Dishier Swrial Number 470442 FO' oweratr ur. er? R•oor•trq atno•
oR Bic 322 PG 1907 ~ APR 24 IIM ~ 15
I certify tttst as to the falowing-named taxpayer. the requirements of section 8325{a) _
of the Intefnal Revenue Code have been aetisfied for the taxes listed below and
for al! statutory .additions. Therefore. ttte lien provided by Code section (1321 for
these taxes and additions has been released. The proper officer M the office t
where the notice of internal revenue tax Iles was filed on Deceaxber 21
~ ~ ~ 9 79 . is authorized to note the books to show the release of this lien for
these taxes and additions. 4 .
Name of Taxpayer
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Resi
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Unpaid B~atres
Kind of Tax Tax Period Ended Date of anent IdentHying Number of Assessment
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Place of Filing
Cta~elc !ir Q3~dt awiet Tote! _
it~. L~r Qa~~ OrA¦e;loiw . ?;31x.4!
lra~L llee~ !Zelda 3li?~
This certificate was prepared and signed at Jacksonville, Florida ~ this,
the 14 day of ri .19 8U
Signature , ~ Title
Van E. 0'Ne Chief S ecial Procedures Staf fe
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(Not~c C•rtirrurs of oHlcq •uthaiz•d ey Mw to f•ke •cknowr•Opmtxifs rs not on•ntiar to tM varlditp o/ Nork~ of
F•drd Tex UM O.C.M. 26t1o, 1D50-r, C.B. f26.) p~
Part 3 - To be used for recording purposers Form 688 (Rev. &78)