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<br />Fc"", 668
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<br />(/l!iIH Dt><;"t',;",;till' 1Y8"
<br />
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<br />
<br />T ax Period
<br />Ended I klimtllyl"ll NumblIr
<br />(hi' (et
<br />----+-.-.---------
<br />1 hn...." I :tuf, -1iH~04a
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<br />.".1........"___,..",,.._..
<br />
<br />I Certlfic:;;m;~ o~;I::: ~;";;;;a~~;ax lien
<br />
<br />DiS1rkt ---1---------TS&fi;;INumb>> ~~.. ? I For Optiona/Use by R8Cording Olflce
<br />OrlIatla 47 I.. _",_~J9A-Cl i
<br />
<br />_._________J._.________,__~
<br />
<br />I certify that as to the following-named taxpayer, the reQuirements of sect!on 8325(8) of the I
<br />Inlefnal Revenul> Code have been .."sHod lor tM ta,.. listed below and 10' ail 51otdtory i 84 - 003249
<br />addHi01\t, Therefore, the jjef1 provided by Code section 63'21 for th6Se taxe$; aod addi1ioos flas I
<br />been released. The- proper OfHClJf in tne oHir;:e where the-notice- of intemal revenue la')!: Hen was
<br />IIIed on 11/10 , 19~ 's oulOo"_ to Mt. tM boo"" to sIlow Ihe "'""""01 thisllan
<br />
<br />
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<br />::=-::~;c._~'~:~--~
<br />
<br />
<br />Gr_ 11 land ..tfll)rll.sJc il ~l I
<br />
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<br />KIM of Tax
<br />(a)
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<br />~'ol'!llllg
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<br />____L____.__
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<br />I 'J7-7.7~
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<br />,_._._J,,__,_..___..,,_L______
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<br />ie91st~ of 1leWt.
<br />KaH ~tcY IwUlJ hl~. ~uh ~l
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<br />'fhi'& .cf!fhHtate: ',!foUl. PfOfhlH~d $:1,{): ;,ilQP~j oj; ,~_~.~~~.:~~!_~_~_,,~~:~~.<~.~___<
<br />
<br />u.._]~3,~~ drh" i)! ,~_,__..~~~~-~~."----,._~._~ }9~_'::~~
<br />5~n4to'.~-~ - ,- _.""~~.J;' "7" /"'T:1""\- - -- "'-",;0;;,. ".
<br />'.. ~~" C/ltvfA) :
<br />.,..- ~ .4 l' t;'h pi, "'h,;.. '" ~" -
<br />__.:~~.:.:-=-'US __.~_,__,_____.l.._.;_;,:.::!,;.2pt'C:dl
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<br />Total
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<br />OOIltI.k.
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<br />Pn:>o.!!dut'es
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<br />t',1~_li' :.;',:lo-,1(~-....:~..c},:,;~'-i"'._rrr;:, .~ ~~T.~i<~' ',~ tr'i<! ~"':l:,.;jjt't.;;f 1'~-t!{1!t of r'f'd~dQi Te:li tH~'n
<br />
<br />P"'l'l "3 ~ 'J () be u.s.ed f~ fKOfding PUf1)OIlt&
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<br />----l
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