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a~ DENIRTMENT OF T1iE TlE/~XIf-N~RNAI lEVENUE ~YlCE
' Fw OpfiOr-ol Ufe Ay Recordng O~Fct
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(aEV. ~ `
C~TIRCATE Of RELEASE Of ~AL TAX UEN
DIST~'T
IA~KSON
jLLE SERIAL NUMBER ~j ~O
.
Y 288140 bt-230 pg-852
1 hereby certify thot as to the following-named toxpayer the requirements of $edion 19M MAR 18 AM 11: 09
6325(a), Internal Revenue Code, have been sqtisfied wifh resp~ct to the taxes enu-
meroted. betow, together with all statutory additions provided by Section 6341; ond i!LE ~ bE 0
thar the I~en for such ~oxes ond staturory additi«a has N~e~eby beer~ released. The s R~~~
A
A.
proper o!F'icer in the office where notice_qf internol reverwe tax lie~ wos Rled on
Julv 30th
19
i
h
M T
S
CI.ER!( CfpClqT C T
,
.L4_,
s
ereby authorized to
ake notation
on his books to show the ~elease of said-lien, insofar as the lien relates to the folbw-
~~OR~t ~'~q~r ~.r~_ __ _
ing taxa.
NAME OF TAXPAYER . ~
t~ty s ~,~~ ~. ~
~~°~:£~ a~c ~
~!. OL~a, 1~s. 9~0
UNPAID BALANCE
KIND OF TAX TAX PERIOD ENDEO DATE OF ASSESSMENT IDENTIFlfING NUM6ER OF ASSESSMENT
lal ro1 k) idl (el
10~0 22~~b~69 04~-17w-7~0 622.19
20~0 I3~.7+0 ~-14•~1 2i3~36•821~0 33i.i8
10~0 1~3~72 ~3~4•T3 ~63~36~52'~ 185.?~
ic~ La.s~•.T3 c~6-~,~.7~4 ab~h3i~r~o 3n.9~t
PLACE OF FILING
S?. l~lClE OO U~tTY
~T p~ ~ TOTAL S 1.506.34
wITNESS my hand ar Jacksom~ille~ Florida , o~ rh~s,
~ 26th ~r ofFebruarS- , t9 81
SIGNATURE i , / 1 TITLE
y/
Van E. 0' Neal ~~ •
(NOTE: ~ertiBcate of of5cer outhaized by low ro toke ocknowledgments is no~ asentid 10 ~he~ of Noh~~d Taz l~en G.C.M.
26419, C.B. 1950-S1, 125.) Z~
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~ PART 3-To b~ used for rtcording purposb~ _
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