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<br />Fpm ~~: -- Y IIeRertment of the Troasuri! - Internet Rovenue ServTice <br />~~~~~~Al~i ~~ R~~~dS~ U! f~sU6~~1 i ~w ~~us~ _ <br />tnav.'SeRtember t976} .. - - - - <br />1 Serial hiumber For optional vsa br RacarUia9 orrrce <br />DistrtCt <br />i cerlifytft~t as to the following-named taxpayer, the requirements of section 6325Ia) <br />of the intemat Revenue Code have been satisfied for 'he taxes listed below and <br />#ar ail staf~,tary additions. There#ore, the licit Rrovided by Code section 6321 #or <br />` these taxes and additions has been released. The Rrope- officer in the office <br />where The native of intemai revenue tax lien was #iled on T=n„ar3-] ~ , <br />#g,~c ~, is authorized to notes the books to show the release of this lien for <br />tit taxes and additions. <br />'r <br />~ Natie of Taxpayer <br />" - -- <br />91 Tax j Tea S'~iad Ere~d ate o4 Assessment ~ IdentHying Nuertber ~ ~ tP~ <br />' tb1 tcJ [a} <br />~~ate)~~ea .g ~r~ y <br />--- <br />~= fi <br />Rferxi Gf Elting <br />.... .Pt...".~.+it Tr1..~ ~llri...s...l.. ICtE#J'3+~ <br />~ _ ---,_„ , On this, <br />This certificate was Rrepared and signed at _ <br />the 15th daY of -- '~%'~ ~ -- <br /> <br />~`..ewh,~ Et jjf,/Z r.r~if(/y~~j~ j 4FIIC <br />5}it'"''"'^^`"' )Ft)fjnai~dGG(J/ erlsVt f"-~s_ i Chie€, Special Procedures Staf€ <br />tfioib: Certirtcate of Wticar aurMOrixed IIy law to mke acknowted9menis is not essentiaF to the valitlilq o/ !Notice of <br />Fetleral Tex lien 4.C.M. 25at 9, 1950-t, C.H. 726.) <br />t=art 3 - To be used for recording Ru~~ Form ~ (Rew. 8.78) t <br />_. <br />~~ <br /> <br /> <br />