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form 6lB~ DEPARTMENT OF THE TiEASURY-NTEWAL REVENUE SENKE FOr Optional Usr Sy Recording Office
;R~ ~ t an l CERTIfiCATE OF RELEASE ~F FEDNtAI TAX l1EN
DISTRICT ~3x'~3~ SERIAL NUMBER
286101 Bk 229 Pg 1043
I F.areby certify that as to the followir>g~named taxpayer the requirements of Section
6325(a), Internal Revenue Code, have been satisfied with respect to the taxes enu- te0~ A~G 1
merated below, together with all statutory additions provided by Section 6321; and wW ~ ~ ~ ZB
shot 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 ~ •
July S , 191, is hereby authorized to rttioke notation
. on his books to show the release of said lien, insofar as the lien relates to the follow-
ing taxes. RftOROYEfIfiflCO,.
NAME OF TAXPAYER
alti.rt a.K.orr alto a.erdea baea+r 49S'?'3'~
RESIDENCE
~ N. C:~MO~at Dpi~~ ~rl3~ ~1L, Cr3.if.
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
Ia1 (b) ~ k) (dl Ie)
10~ ~ 12-31~T3 4-~5-TI~ 12t~03'~~ 33,5a1~13
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PLACE OF FILING ~ ~s~t Caue~
~ TOTAL s 33,5x1•'3
tt.~ rl~erw, !l~ee3ea 334~so
`NITNESS my hard at Jacksonville Florida , on this,
tS ~
i
rye 1St ~y of AuftUSt 19 80
~ SIGNATURE TLE
~ 3~6 ~,~i~ll~
Van E. O'N~al• Chief S ecial Procedures Staff
(NOTE: Certificate of officer o~,thoriZed by low to take ockrwwledgments is not essential to the validity of Notice of Federal Tox Lien G.C.M.
26419, C.B. 1950-51, 125.) dlk
PART 3-To be used for recording purposes