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Fonre 558 Gf'rRR'AtihT Cr :tfE +URS'-CitEWAi cEYE!.y~ SE4NKE I For ~3r•rrono; Um BY Rctaru+ng <br />laEV. ! ~~t l C#R3iffSATE #yf CEASE ~ ~ FAX 1fElf <br />,_tiSfKfCT SERIAL NUMBER aC~~..~ ~~ ~~ i ~ r,~ <br />o~ ~ V ti <br />ection <br />at as fo-the following-named taxpayer the regeiremenis~5 <br />1 reby certifyf <br />b325tat, internal Revenue Lode, have peen satisfied with respect !o the taxes enu- <br />merated bebw, rogether with a1! statutory additions provided by Section b$2.1; artd <br />that the lien for such taxes and statutory addt~ions has thereby been reiecised. 'The <br />iJ <br />i <br />l <br />d <br />f <br />internal rerenue tax <br />ien was* <br />on <br />pri>gex officer in the office where not <br />ce o <br />e <br />i~, l ~'i , 19~~, is hereby authorized to rdake notation ~_ <br />on his books to show the release of said lien, insofar as the lien relates to the follow- <br />!e~ taxes <br />'~ <br />tvMAE OF TAXPAYER <br />"~: <br />RE~fSl~JCE <br /> ~ <br /> , <br /> UNPAID E <br />KIND OF TAX TAX F!ERIOD ENDED DATE Of ASSESSMENT IDENTIFYING NUMBER OF NT <br />tai lbl [d tdl t <br /> ~~ <br /> .., <br /> <br /> k <br />~' <br /> <br /> ~~. <br /> ~:: <br /> <br />PfAGE Oi' FILING r .~ <br />;~ <br />~,; TOTAL $ ~,~ <br /> <br />WITNESS my hand at (knaj~s NAh~~4a , on this, <br />ihe~-Cb.Vdoy of apps 7 , { <br />SIGNATURE ,/ ~ ii~~ //f~ f S. ~ i TITLE <br />d J. ~~rfs e'°~~~-» ~ Chief, Special Procedures Staff <br />(NOTE: Certificate of officer nuthorized by law to fake acknowledgments is not essential to the validity of Nonce of Federal Tax Uen G.C.M. <br />264!9, C.B. 1950-S1, 125.) <br />PART 3-To bs used for recordhyf purpmos <br /> <br /> <br />