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Form OEa ' OErMiMENT Of TiIE TREASIMY- NTEIINAL IIEVENUE sE)IYCE For Optional Use 8y RscorWnp OfflC~- - ,
(REV. saet CERT~ICATf OF R~.E119E OF FEDERAL TAX LAN ~ .
DISTRICT SERIAL NUMBER
' 353105 BK 26 PG
I hereby yy~~1fY that as to the fdlowing-named taxpayer the requirements of section
6325(a~ In3emal Revenue Code. have been satisfied with respect to the taxes t3nu-
merated below, together with all statutory additions provided by. section 6321; and ~ MAY 20 ~ j~ OS
that the lien for such taxes and statutory additions has thereby been released. The
pr o I )n office where notice of internal revenue tax lien was filed on
°~e~ 1976 19 is hereby authorized to make notation Fp A ikE
on the books to show the release of said lien, insofar as the lien relates to the fellow- ~ ~
Ing taX@S. . .
NAME OF TAXPAYER -
- 48'70'74
RESIDENCE
7~ M~
UNPAID EIA(J?NCE
'i KIND OF TAX TAX PERIOD ENDED GATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
i (a) (b) (c) (d) (e)
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14
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PLACE OF FILING Q~t ~
~ ~ t~if~ ~ TOTAL
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WITNESS my hand at Jacksonville, .Florida - , on this,
k
~ the 17th ~y ~ Apri 1 , ~
SIGNATURE J TITLE
Van E. ~ Chief S ecial Procedures Staff
(NOTE: Csrtifitate of officer authorized by law f take acluwwledaments is not essential to tM validity of Notice o1 Federal Tax Uen Q.C.M.
teats, cs. ~QSO-~. yrs.) RW
PART 3 - To be used for recording purp~1 Pl~i~ ~G