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trorrn Oepertment of the Treewry - lotemal Rrrenw Service
i (rtev.S.pt.mb.r,e79) Certificate of Release of Federal Tax Uen
District Serial Number ~i~O
J Fo. opnona( us. a? n.eow~w omc.
J~11~31ia F161dria 20 2 Bk334 P 1299
I certify that as to the following-named taxpayer. the requirements of section 6325(a) c = k~
of the Internal Revenue Code have been satisfied for the taxes listed below and
for all statutory additions. Therefore. the lien Provided by Code section 6321 for
these taxes and additions ttas been released. The proper officer in the office
where the notice of iritema! revenue tax lien was filed on iuly 8 ,-.gran t~air~~a. _ _ _
~ 19 80 , is authorized to note the books to show the release of this lien for
these taxes and additions.
Name of Taxpayer
i ~1•ts ~rai~le Ian.
Residence
vita ~F~
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assessment identifying Number of Assessment
(a) (b) (e) [dl (e)
i ( ~1/
3t o6-09-~ ~
6
I
! Place of Filing Q,~ ~ ~ a>l~t ~
8t. Lrd~ B
Total s Ze~•~
rose! Pl~aoo.. rLel~ia ~
This certificate was prepared and signed at Jacksonville, Florida , on this.
the 30th dgy of Se to X19 ti0
Signature / Title
Van E. O~Nea Chiefr S ecial Procedures Staff
Mar. Certificate of offleer authorized by law to rake acknowpdpmsnts Is not tM v oL Noric• 01
FMen/ Tax Lien O.C.M. 26119, tSSal, C.B. f2b.) ~ f~f)r -
BOOK~~
t~ P1GE ,
Part 3 - To be used for recording purposes Form 868 (Rev. X78)
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