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F~ CCA Department ~ ths Trottury - Intemal R~vNw~ SKViCe
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~Re~.se~om~,s~, Certi~icate of Release of Federai Tax lien
Ristrict Serial Number Fw o~,o~.i us. ~y a.~o.ar.~-orrr~.
! 548627 BK 356 PG 2192 ~~T i a ~~~7
I certity ttwt as to the idlowing-named taxpayer. the requirements of section 6525(a) Ft! a~+[ c~~~~~:. -
; of the Intemal Revenue Code have been satisfied for the taxes listed below and s RcG!it
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for ail statutory additions. Therefore. the lien pravided by t'.ode section 8321 for c~EFx ~IRCUiF l'~' , 6~' ~
; ihese taxes and additions has been releaseci. The proper officer in the office q~
whe~e ihe notice of intemai revenue tax lie~ was filed on Nov 13 . U-
19~_, is suthorized to note the books to show the release of this lie~ for -
: these taxes and additions. -
Name of TaxPaYer .
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Resldenoe
1~# Af?+ 3345~
~ UnpsW Balancs
KJnd of Tax Tax Period Endsd Date of Assessrt~ent tdentihrin~ Number of Assessrt~ent
w ta~ t~~ rw t.~
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' 9~/~ l,a-3t-?~ o~l~-Z7~-ai uo-38-25~ 33~5.99
~ i400~ PMa~
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~ Place of Filing -
* C~sit o~ !bs Cl:+a~dt Cw~rt -
v 9t. L~rO~i~ CAlrf~ C~IOel~ro~s~ Total i 3~5•99
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" This certificate was prepared and signed at Jacksonville. Florida
, on mis.
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~ the_28.t~ dsyof Sentember,l9 83
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~ Signature Title ~
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A. W. Sendl~ Chief, Advisory UnY~ ~
Mot~c CMtHrut~ w autAatr~d by !~w ro taJcs acknowbd~ym~na h not ~sa~?rttal to tM rali0lty o/ Nodc~ of
~ F.a«.i r.r u.n o. ..se+~~ ~aaa~.c.e. ~z~.) ccc 9/28/83 rg ~
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~ Part 3- To be used fo~ recording purposes Form 668 (~tev. 9-~8)
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