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PLACE O~ FILING ~~t ~ ~t C~~t
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pEPApTYENT Oi TNf TREASii11Y - MtT6ili~l ifEY~ SE~iViCf Fw OPtrons! Ust BY RecorOing U/7~cv
~REV iei~- CERTIFICATE OF RELEASE OF FEDERAL TAX LIEN
OISTRICT SERIAL NUMBER S,~1Va~
• :3ii~i121 4 4 2
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i hereby cenify tfiat as to the foilowing-named taxpayer the requirements of section
63251a1. Internal Revenue Code. have Deen satisfied with respect to the taxes enu-
and
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merated below. together with all statutory additions prov •
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that the lien for such taxes and statutory add~tions has thereby been released. The
prope~ officer ~n the oifice where noUCa of intemal revenue tax Gen was filed on ~tl! C--t! << (.;~; f;;
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~s hereb authonzed to make notation
_ M~x 18 h _. 191$_. Y .
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on the books to show the release of said ben. msofar as the I~er. relates to the tollow- ~:.~~,~ C'-.:^t:' r~:
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~ng taxes. ~
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NAME OF TAXPAYER
~'M Mlfll~s '
5~135
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RESIDENCE
1~7 1i. 13ti ~ttMt
UNPAID BALANCE
KiNO OF TAX TAX PER100 ENOED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT
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10~ 1~-31-7N OY-G5-77 115-20-119~'2 ~ I~043.a0
iti40 12-3I-75 Ob-Z3-?'t • 99~7.9~
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TOTALI$ Z~l~~
WITNESS my hand at Jack~onv~ lle, Fla , on this.
the 16th day of bfarch _ 19.~ 1
SIGNATURE TI7l.E
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~NOTE Certrt~~~te o} off~cer aucno•aed ay ~aw to tawe acknowiedymen:s ~s not es52nU01 t0 tA8 vd:~d~ty of Not~ce of Fedsral 1s: l~sn G.C M
26419.C 8 1950~1 ;25!
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PART 5- To be used for recording purposes i'~~~~ ~~.~ ~~~
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