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F~ ~~~ . Ospartmsnt ol fAe Trsaaury • Intemal R~venue Ssrvice ~
~~.,-~~,9~, Cer~ficate of Release of Federai Tax Lien
Dist~ict Se~ial Numbe~ ~~ For o WM/ USA Dy RlCO141 onke
422661 BK-297 -803 ~~ ~ 9 ~ ~~: 08
I hereby ceNify that as to the following•Ramed taxpayer the requirements of f LE F Cpppf~p
section 6325(a). Internal Revenue Code. have been satisfied with respect to the gf ~ ~~i~~~-
taxes enumerated below. together with all statutory additions provided by section R ag
6321; and that the Iien for such ~axes and statutory additions has thereby been ~~~~'~.~w~c~r-D
released. The proper oifi er in the office where notice of internal revenue tax lien °Ftckf~ ~~-p~rJ~, ._ _ p~(
Nove~er 3 ~~ ~~
was tiled on , 19]$_, is hereby authorized io Cf~
make notation on the bo~ks to show the release of said lien, insofar as the lien ~~
~elaies to the following taxes. _
~ Name of Taxpayer
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; w~s ~s ~wr
~ Residence
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' Unpaid Balance
Kind of Tax Tax P~riod Endsd Date of Asssssment Identif~ring Number ! ot Assessment
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Place of Filing
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WItn888 my hand at Jacksonville, Florida
the ?~th day of February ~q 81
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, on this,
Signature r j I Title
Van E. 0'Neal ~~~, ~ ief, Special Procedures Staff
(NoN: Cerlilicafe ol ollicer aufho~lrea by law fo fake ackno.rlecrgmenfs ~s nol ,essen ~ fAe valyd~t o/ Nol~ce ol
Fedenl Tax Cien O.C.AI. 26I19 C.B. 1954t. I?5-) (~
PaK 3- To be used for recordirp purpose~ ~~' ~~~
_ ~rm 668 (Rev. 1•78-
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