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F~ ~~~ Oopa~tmMt of the Trepury - IntKnal R~vMw Service
~~R~,.~.~~.,~,8, Certificate of Release of Federai Tax Lien
Dist~ict -• - Serial Number r-J1~6~ Fw OPNonN !b~ DY A~condinp OfHC~
Ja~°~'°"'iu~~ ll~oel~ 496817 Bk 337 Pg 109 f EB I 3 AN ~ 04
ftlER ~1~~E C~ D
I Certity th~ 8s t,o the idlOwing-n8med texpeyer. thA requirements of SeCtion 6325(8) SI.IUC~E C01hlT . FL A_
of the Intemal Revenue Code have been sstisfied for the taxes listed below and RoGER POITRAS
for all statutory additions. Therefore. d~e lien provided by C.ode section 6321 for ~~~ ~IRCiHT CO t~
the~e taxes and additions has been relea~ed. The P~oPer offioer i„~h@ Off~f ~GR~: : r~:r~c ~ -~ _- ----
~ the notke of intemal revenue tax lien was filed on Auguat ~u
19 is authorized to note the books to show the rel~se of this lien for Si~b~
tl~ese taxes and additions.
Name of Taxpay~er
Jd~ ~. Q~
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UnpsW B~
Kind of Ta~c Tax Period Endad Date ot A~nen: Identii~ltrq Number of Assessrt~e~t
~ (aI [b1 (c) (d) (~1 .
' gqo 12-3~1JS 3d-~3~ 9S.3b
~ 9~i i2-3t-7S d~~ 3d-~3~ 33~.06
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; 94t 09-3D-76 ~-3-tT-T! 3a-~o63Qi1 ~2.Id
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St. Iaai~ Oo~i, Cvusl~au~t Totat = 1.~'~'i
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This certificate was prepared and signed at Jackaornille, Florida ' , on this,
the 29th ~y~Janua~r-~ ~g 81
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Signature CJ / j Title
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Van ~. 0'Neal ~ • Chief. Special Procedures Staff
(1~01K CMfiliCafs Of OifiClf 1YfhOIfZAd by I~M f0 fakY ICkf10~M~Op/IIMt! b f10f MfIU f0 fM Ydidky O/ NOfiCO a h~°
G F~Os~N Ta~c Liwr O.C.M. 26~19. 1~541. C.B. 126.) a~t~ ~pC~~~
~ Pan 3- To be used for r~adl~ purpose:~ Form 688 (Rev. ~78)
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