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I <br />~,I:,,„ <br />Form G "~, ,.~ aEPARTMENT PF 7NE TR~ASt)'~Y-fP1TEktC:A1. RE4"ENUE SHC1fCE <br />} (REV. 1 7©} ~ CET~I~TE RELEASE IDf ~IEt~tA!' iAJC 9:1lP6 <br />D}STWCT ^~-~~-~ ~-+I,-`SERIAL N!lMiBEE <br />ktxwi{s ~ 'I I~ i~d <br />! I: hereby certify that as to the foltowin~-nomeei taxpayer the requirements of Section <br />b325ja), lmernat-Roveaue Code, have been satistted with respect ro the taxes enu- <br />meroted fselow, together with ott statutory additions provided by Section 6321; and <br />..that the;:lien for-such taxes and statutory additions- hos hhereby been released. The <br />- proper officer in the oftke whero notice~~If~~f__ inferrtot revenue tax lien was died on <br />if - r_ ~ , 7 9~, is hereby authorized to make notafion <br />I oa his banks to show the releose of said lien, imofor as the &en relates to tha foltow• <br />;ng loxes <br />NAME OF TAXR4Yf3t <br />~~ <br />} ~ ~ <br />(' <br />tZCE 191x. <br />i ~~~~. <br />r: <br />~. <br />fOr Qphiwwl U,e~ Bmy~W~ecwc <br />` pfdD OF TAX ~ TAX ?ER1OD ENDED t ASSESSMENT DATE IDEiVTIFYiNG NUMBER <br />la) t61 k2 (dI <br /> 9 -.3~- ~ 3-~ 1-'397~td'~ <br /> T~-~-7~ } X73 4!'~#.T <br /> 29-~i. ~ ~-' ~ ~7~-OS3?1k7 <br /> [ t <br />TITLE <br />UPIPAID ItAIAN~ <br />OF ASSESSMENT <br />4et <br />- - (NOTE: Certiticate of oFFicer authwrized bYry^ to take ocknowledgments is not esmnfiol to the valid'ny aF Notice aF federal Tox Lien G.C.M. <br />24414, C.B. 1450-51, 125.} <br />PART 3--To be used for roeordtnp purpows <br /> <br />t_ <br />