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Fot~ Ospartm•nt of tM TrNwry - Mt•rnal RevM~w SMVECe
tR•v.etfpt.mb.rto7a, Certificate of Release of Federal Tax lien
District Serial Number For ooNwnl va. a w.eordrg tmlc.
491279 Bk333 P 3000 f~0 SEP 3p AM ~ 33
I certify that as to the fdlowinB-named taxpayer. the requirements of section d325(a)
of the Internal Revenue Code have been satisfied for the taxes listed below and F E p
for all staRutory additions. Therefore.•the INn prarided iy Code~aecMen~321 fOr _ T~ lt.
these taxes and additions has been released. The proper officer in the offbe t~ltWlt ~T -
where the notice of internal revenue tax lien eras filed on Tune 30 trcnan ?~RIrtEQ__.__--
19_~~. is authorised b note the books b show the release of this Nen for
these taxes and additions.
Name of Taxpayer
Residence 1~ ~!j
~ .
unpaid eaiancs
Kind of Tax Tax Period Ended Date of Assessrttsnt Identllyinp Nixtiber of Assessment
ly (b) (c) (dI
~ .
.
r ~
/ /
i Place of Filing ~ ~ ilk ~ ill~t
_ _
R. l1+~a 1fl~sLis ~ ~ Total = { i~u~
This certificate was prepared and signed at Jacksonville . Florida ~ pn b,ig,
the 25th day of ,~g ~
S;g„~ Tine .
~Q~
an ' eal ` ~ Chief S ecial~Procedures Staff
prase c..raica a oM~cr .ufAorlt.e by aw ro plc. .~knowbgo~m a not iM otlc. a
F.O.ral Tv Lan o.aM.2~ta~osa~.c.a t2s.) ~Q~Kt~ct~
Part 3 - TO be used for reCOrdafp purposes Form fj88 (Rav. X78)
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