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Fwm ~ ~ . OEPARTYENT Of THE iNEA3Ully- lITERNAL (IEYENUE SERVRE For Optional Uts 8y Rrrcordlny OBka
(REV.'-i~ CERTFICATE OF RELEASE OF FEDEML T!!X LEN -
DISTRICT _ SERIAL NUMBER •
358678 Bk 264 Pg 1340 ~ •
I hereby certify that as to the following-named taxpayer the requirements of section ,
6325(a). Internal Revenue Code, have been satisfied. with respect to the taxes enu- ~
merated below. together with all statutory additions provided by section 6321; and .
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
February 28 19~, is hereby authorized to make notation
on the books to show the release of said lien. insofar as the lien relates to the follow- .
ing taxes. ~ ~t
NAME OF TAXPAYER ~ -
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REST ENCE
~ t~ a+4L~',~'081
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UNPA)D BALANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
(a) (b) (c) (d) (s)
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PLACE OF FILING
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Jacksonville, Florida
'4 WITNESS my hand at , on this,
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the 16 ~ ~ April .19 80_
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SIGNATURE J TITLE
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Van E. 0 ~ CHIEF, SPECIAL PROCEDURES STAFF jth f
(NOTE= Certitit.ate of officer authorized by taw to ke acknorNedgments Is nol essential to the validity of Notice of Fedsnl Tax Lien G.C.M. #
2d41Y, C.B. t~bt}t, 12b-)
PART 3 - To be used for recording purposes 40~~