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Form Department ot the Treasury - Intemal Revenue Service ~
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' (Rev. September 1978)
' Certificate of Release of Federal Tax Lien
, DiStrict Serial Number 470~31 Foi Optiona/ Use by Recordiny Oflica
J o.R. 322 PG 1896 i983 f:~~~ ~ 0;;~ a 05
I certify that as to the following-nameri taxpayer, the requirements of section 6325(a) ~ •
of the Intemal Revenue Code have been satisfied for the taxes listed below and ~ c~~=:.`~
for all statutory additions. Therefore, the lien provided by Code section 6321 for '~i f~n
?hese taxes and additions has been released. The proper officer in the office ~ ~ ~
where the notice of internal revenue tax lien was filed on December 21 =-;~j
19~_, is autho~ized to note the boaks to show the release of this lien for v
these taxes and additions. 6~~~
Name of Taxpayer
AE~ J~ Jra
Residence ~pl S~im ~Ol~e!
FCet Pi~t~~ llae~ida 331~y0
Unpaid Balance
Kind of Tax Tax Period Ended Date of Assessment I Identifying Number of Assessment
te) (b) (cJ ' (d) (e)
' 10J~0 L3-3~Tr 05-~-T9 ~bl~-6b-6~j 603.ji~4
~ 14b0 i~31-?~ ~~-79 I 261-bb-b2B3 536•9~
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~ P1ace of Filing ~ ~ ~ ~
€ 9!'' L~t~ Oa~ Total = 1~~Ae1~0 ~
1ror6 Fi~s~ ~1°rlda 33~0 ~ ~
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This certificate was prepared and signed at Jacksonvil le, Flor ida , on this,
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~ the Sth dayof August 19 83
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~ Signature Title . ~
h~'~~:"~. Sendler Chief , Advisory Unit
(Nots: Certificate o/ officer authorized by !aw to take acknow(edyments Is not essentisl to tha validtty ol Notice oJ
Fede~a! 7ax Lien G.C.M.28419, 1950-1,C.B. 125.) CS CCC $-,rj-83
Part 3- To be used for recording purposes F~~m 6$$ ~F~v. ~3'78!
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