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(Rw. S~pbmbK 1978)I
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'. D~p~rtmont of the T~ury • Mtsmal iNvMw 3uvic~
Certifica'te bf Release of Federal Tax Lien
D~tric} Serial Number S ~9 Fo- OP~ond UN b~- R~ea+d'uq OIHc~
491271 Bk333 Pg2992 ~60 OEC 23 ~!I ~ 08
1 certify that as ta the fdlowing-named taxpayer. the requirements of section 6325(a)
of the Intemal Revenue Code hava been aatisfiec! for the taxes listed below and
s E T'
for ali staiutory additions. Therefore. the lien provided by C.ode section 6321 for . CN191NT t~OURt
u
these taxes and additions has been reteased. The proper off~~rein~ahe oHice REC~Rp ~EP~~ p ._
where the notioe of intemal revenue tax iien was ~led on ,
~
19
, is suthorized to note the books to show the release of this lien for 11
4~9
the.~e taxes and additions. 5
,
Name of Taxpayer
lriis~rt•s ~~e~. Tar.. s ~er~Mii~
Residenoe
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Unpaid Balance
Klnd oi Tax Tax Period Ended Date oi Assessment Identityiny Number of Assasament
U) (6) !c1 (d) [~)
~ ~Ni~~•~ ~'~'~A ~
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9 ~ l~ii ~
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~ Pla~ ili~~t ~t -
~. Lrt~ a~A~ Owa~ir~1
~'t. ~i~s+~, tl. ~~
Total = ~~~.64
,
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This CertifiCate was prepared end signed et .lacksonville, Florida , On this,
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~ the ?nd dayof .19 80 `
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~ Signature Title .
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cNa~ csmirur. a ar~er .~,rnoruee by a,. ro a~e .~~o«~~~.e~n ,~: w ro r w~auy a Naks a
F~a/ T~r LNn O.C.M. 26~f0, fa541. C.B. f25.) B~`~P~~~~A p88 -
1
Pert 3- TO be used for reCOrdin~ pu~poses _ Form ~68 (Rev. 5-78)
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