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Fprm ~~ ~ Daep~anrtmenst of thxe.,'Trpe~ajsury-lnte$mat-gevenuegSarvis+e~ - <br />(Rev.6eptemberi978j~ C~C~C~#e ~1 ~L74ia~ ~E~- ~~~~p~ ~pX ~~~` <br />I cert as to. the fallowingn~ed taxpayer, fhe requirements of section 632~a7 <br />' of the Internal Revenue Code have been satisfied for the taxes listed below and <br />fior all statutory addftions. Therefore, the lien provided by Code section 6321 for <br />- these faxes and addftions has been released. The proper officer in the office <br />where the notice of internal revenue lax lien was filed on lf-~ <br />19 !s authorized to note the b~ks to show the release of this lien for <br />these yes and additions. <br />Name of Taxpayer <br />HefrAR3xi ii. aced !'a H. !'1,t6G.' <br />Residence <br />LtiiFa 2+) <br />For ^.f#fa/+aF Use'by Raeor6!»g Offtee - <br />8~--trt ~~~~ <br /> <br />Kind aef Tax <br />€aj <br />~ <br />~ Tax PeHod Ended <br />(b7 <br />Date of Assessment <br />(c) <br />IdeMifytng Numtjer <br />(d) Unpaid 881anCo <br />of Asaessmmjt' ' <br />€e) <br />~' "~, ,W (7auc .i~}: <br />~ alTJi' ,~* is"gga'~ <br />t~ <br /> _.r <br />slf r <br />~yf~ <br /> <br /> <br />- ~ "~ <br /> <br />1 <br />,,.~ <br />I <br /> <br />~_ I <br />`. i <br /> <br />I <br />,. ,.y <br />' Q~ ~i7B .r i <br />~. R7 tE~ == Total ' S 9-730.~9 <br />efi9..,.r;;: ,. <br />i ~ __ <br />' This certificate was prepared and signed at ____Otnaha, Nebraska __ ~_.__ , on this, <br />the 1st dayofOctober .ig - 80_~ <br />__, _ <br />Signature -7~ t~Et.~~,~ ----- -Title --_.. -. <br />~,_ ~l~j Donald ,I. Ghlerr3 j Chief,_Spzcial Procedures <br />(P{pt+A: Cwtll/Cats Df arficw authorzzid M few to fakB acknow)Wpmenf9 rs no 699ennal to mo validlfy Of Noflca Uf <br />FaWre! rix Lhn O.C. N. 26of Y, tp6P f, C.9. fY9.) <br />Part 3 - To Ije used for recording purposes Form 668 (Aev. 9~7R? <br /> <br /> <br /> <br />