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<br />Form ~~$ (~p~.{~jl~C~eR}aprtmpa~n{t of thpe l?re*a3s(u~ry-intie~rnal RgeveYlnue+~SarvT+cey y s4~y <br />(Rev. SeA:amber 1878) 6JrL! L1IiL~iV VQ ~Li~fJJ~ ®f ~iI~4~G~ 1 ~A 61 ~i41 <br />l.~iS#FICt ~ Serlai Number _ t For [Jpfionar Uso by Rocorring 6ttice <br />f <br />F !certify that as to the #crSiowing=named ~aJCPaYer, the r~ quirements of section 6325ta, i <br />of the interna! Revenue Cade have been satisfied .or the taxes tested below and <br />fior ate statetory additions. Therefare, ttte teen provided 6y Gode section 6321 for <br />a ttJ$se tars and additions has tTeen re#eas~d. The fPraper o#f: er in the office <br />where notice of intema{ revenue tax teen was #iled an_~~r , <br />;9 is authorized #a note ttH? beaks fo show the release of this lien for <br />:'=estr taxes and additions. <br />afTaxpayer <br />~ ~ ~~ <br />~ASId@nG8 <br />_~ ~..>..~,..,.ay <br /> <br />otTaz <br />:a} ; _-- _-_ __ _- <br />Tax Period E><tded I <br />ra} I - <br />DsYe cf A~estrt~t ~ <br />} ~ <br />is <br />fidentifying Atuanbet <br />fd} fhtp~d c8 <br />of ar+t <br />ta} <br /> # <br />p~' 1 <br />.A~~iM r ~ ~ <br />s <br />r, <br /> <br /> <br />9 <br />#~~ ~ <br /> <br /> <br />ii <br />i ~_ t <br />~ ~ <br /> <br /> <br />! <br />~ ~~~ <br />~~ <br /> f <br />~ <br /> <br /> <br />1 <br />. I <br />j <br />~ <br />i <br /> <br />i <br />4 <br />Tom' ~ 1.A~.~~' <br />dad ~a - <br />Thus a wr85 txepared arm signal at ~. --- 0!'saha . Nt:kara5ka , on this, <br />~ 5t#t ~~ October ,t9 ;9 <br />---- ---~ <br />i Tat#E <br />t3ora~ tr.~£~~er ~ ~ C~igf, 5,~c;al FrsJC~lti;~s Siaff <br />' £'!3$~eM 2* iR~`~-L~ ei:•••-;=12' '~Y ~e ;i' ilea 3:1r3a~v4xlnramts nE alt tSRi+PTti~' W tM vtLQR4Y Ot Nnece Pt <br />F~Irii TL LNA &~Y. 86iTY, PL'S?.-S, G-$. T2"5} <br />float 3 - TO tae used for ~ p~xPOSas. Form Sda iReu. e-78) <br />L~.~ <br /> <br /> <br />