HomeMy WebLinkAbout0965 -
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~ Form 668 DeDarfmant of the Treasury - Internal Reve~ue Service
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; iRev. September 197H) Certi~icate af Release of Federal Tax Lien ~
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~ District Serial Number 509390 For Uptional Use by Recording Olfete
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0/N 34A PG 962 ~~1~~ q
i JAC3~BORII~ii
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I certify that as to the following-named taxpayer, the requirements of section 6325(a) ~~~t.-' ~ ~ ~N 9~ ~~j
of the intemal Revenue Code have been satisfied for the taxes listed below and r,; g~;,, f t:,,
for atl statutory additions. Therefore, the lien provided by Code section 6321 for ~ E• l. _~C~f cr ..1-
these taxes and additions has been released. The proper officer in the office `~f z'' f'~ ~~~~•~s
where the notice of intemal ~evenue tax lien was filed on 12-5- t~~
~ 19_ R 1 1 , is authorized to note the books to show the release of this lien for
; these taxes and additions.
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' Name of Taxpayer
' Nan~~ o a~?r~m~a 5~•9103
~ Residence
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Z04 8t~'f~i ST~? PC~T PIE~ IR.
' Unpaid Bafance
i Kind of Tax Tax Period Ended Date of Assessment Identifying Number of Assessment
{ (a) (bi (W (dJ fe7
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~ 1040 12~-31-?4 ~6-+16-80 ?23-84-7~190 9~'9•~
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z Piace of Fifing I ;
~ ~ ~ ~ ~ Total ~ Z 909.11
33' I~3CIB t~PTY Ca~ j
F'G1R? P~S. !L I
This certificate was prepared and signed at ~~K`'~-'
i~: ~=LE , F I~~RnI F. _ _ i__ on this,
theZp__-- dayof '~:L'~'~ ,19 -
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5 S~gnature - - Title (iR ~(~O -
t,,°,~;. Sendler CHIEF', l1D`lIS~RY UNIT g~`fl/~ PAGE ~4
(Note: Certrlicate ot otlrcer authorizod 6y !aw to tako acknowledqments is nof essenbal to tho validrty of Notrce of
Federal Tax Lien G.C.M.264t9, 1954t,C.8. 125.)
CCC 7~2: ~S3 d'cj
Part 3- To be used for recording purposes Fc; m 668 (Rev. s-~8!
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