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Fam ~ aputmMt Ot tAS Trea3ury • I~Hrnal Ft~rsnus Ssrvite
~R~, Certificate of Release of Federal Tax Lien
District SerialNumber , ForOpfionalUsebyReco~dingO/IJce
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s97516 bk394 pg2243 ~
~ ~83 OCT 16 AM g 4 7
I certify that as to the following-named taxpayer, the requi~ements of section 63~(a) of the
Intemal Revenue Code have been satisfied for the taxes listed below and for atl statutory F~~~~ ~1~C ~rCf~•~{n
Si.iut;rE f.r<<~",:'r: t
additiona Therefore, the lien provided by Code section q21 for ihese taxes and additions has ~~,G~ .
tieen relea~ed. Thep roper officet i~ the offioe where the notice of iMe?nal revenue tax lien was CLEFi~ ~~f•; r~ r•
filed on- F
eb
28 19~, is authori=ed to note tM books to show the release of this lien -
for these taxes and additlons.
Name ot texpayer
~r.~ r~cco~r 6~8128
Rssidence ~
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Tax Period Dats of Last Day for Unpaid Balance
Kind of Tax Ended Identifying Number AsasssmeM Refiling of Assessment
j N) NI k) (d1 (el t~
i 9~+1~-66r12 ~3-31-$2 29~-~~-,5~yt~ ii-is-82 !2-iS-89 9.~.95
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~ Tnis certificate was prepared and signed at Jacksonville . Florida , on this,
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~ ~ne 5 th day ot October _~g 83
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~ Signature Title
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~ A W
~ (NoN: Certificc?e of off e ocknowf=dgements is not euentiol to validi y of No~ice of Federol Tox lien
~ G.C.M.26r19, 1950-1, 25.) CCC 1~-~-83 a1C
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~ _ Fam 6601Rev t2$21
Part 3- To b~ usad fa noordhp Purpos~s
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