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Rw7n 6SlFF <br />,_..~. a...,~ .,.~. r .. <br />- For Optional Use <br />! t+brbby txytt#ip itwt as to the fatlawtrtg-nsmed iaxppyer the requirements of sect#ttn <br />tom, tntemat Rawatus Gode; Have tieext sati5t#ed-with respit['t io'!he taxes enurtferated <br />D8Ia4K toQirtA6f withatl s!estatar~edd#tians prOVided tsysectio!t-$324: antl'thaf-the-lien tor- <br />suds ty»g and atatutpry adAitinne has tfieYeb!i Been re#eaaed Yti}r d ~r i In the of <br />;ice wttene notiee of rmernat raveque ts;x tten was ttted on d: {j"~ <br />19 ~ hrN % euttu.+rizeA to [eYetce natatitrn on thb trooks a sitiD"vr the ret~sa#d lien.. - <br />itssQtar>~ tits #kn [elAtee to the #vNawtnq:t~xes. <br />l7ame 3f Taxpsyeh - <br />~ I <br />r <br />~_ <br />Kt+tfsQf YgX Fd~' Tax Pt~od Enried pate Of Assessment i Idenftfyinq Num9er <br />(~ ~ C~1 tcl (ti) i te1- -- <br />~~~~~ ~ ~ Total ~ S <br />_ ~~~~ ~ s <br />~~-{ <br />NoitCe ai Federal Tax lien Refiitr~g <br />.~~ ',, a.__.T~ _ iiecard~'slaenlttrcattonNa .... ....... ..__,_.~.,._.....~_ <br />- DitlttCe Fi1a$ thlffiT ~_. ~~~ -. - - - -- -- __.. - `r?at6 _.._, ._ _ _. - - _.___,..__ <br />b«~ ## chtterextt than shn3rn ~~+e! _ , <br />:- _ _ ,.-, <br />f1t!tdttd, "i86r~5ka ~-_ _.._._,anihis. <br />€t~tir tsamct 7s! ___ _ _.. _ _ .. .- .. _ . _ .. _ - <br />t_...i$fih ,at ~uttt t9 ~~ <br />Tote Chief, Special Procedures <br />~ft~]d i. £htors <br />~19fis Cacltisrasxa of affiCer autttar#z#~i by #a~ to taitE actc~wietlgrrtrsrtts .s nryt es&entrai# tr! the va#idety of Notice ci <br />t?atWrid Tatt tt,en G.C.M. 2~f49, G,$. iQ50~t, 125.) <br />Pact 4 ~ To Etta usaA fmr ntmdNsY P <br /> <br /> <br />