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FORM DR- 302 .
STATE OF FLORIDA
2''1s~~ DEPARTMENT OF REVENUE E
oE s ~ j~ ;,UUN1Y fLA.
_ ~''~'o~ ESTATE TAX BUREAU ^ _
~ ~ a TALLAHASSEE, FLORIDA 32304 ~~EaK Cf ~~c cAC4uRT t~
, - ~a RFGOR•^- YE `.Et~ ~ •
'-4~,~~~' ~ lt 10 Z9 AN'?Z :
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J EDSTRAUGNN NON-TAXABLE CERTIFICATE AND RECEIPT ~~1~~?7
E~ECUT~vE o~AEt,~ FOR ESTATE TAX
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TO:
Mrs. Anne B. Grooms, Spouse
~ 206 No. 18th Street A~ 4_~ PP
~ Fort Pierce, Florida 33450
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~ Re : The Estate of Fred E. Grooms
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~ Deceased.
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~ Resident of St . Lucie
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{ County, Florida
~ pgte; .7anuar~,_~, 1972
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$5.00 ~tFee. Received : December ~O, ~ 97~
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4 THIS IS TO CERTIFY, That in accordance with the provisions of Chapter 198,
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~ E'lorida Statutes, there has been filed w ith this office a sworn report or return for Estate
~ Taxes as required by law and on the basis thereof it has been ascertained the above estate
= is not subject to the Florida Estate Tax. The issuance of this certificate, hov+ever, shall
not preclude the assessment and collection of Estate Taxes subsequently determined to be
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~ due the State of Florida.
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If proof of non liabilit~~ by the above estate for the Florida Estate Tax is required
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~ by any person this Certificate may be exhibited as evidence of such non liability.
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(:iven in quadruplicate under my hand and the seal of the $tate af Florida the
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` date first above written. -
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- , Z~ ~'`'~9 -
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= Executive Director
Uepartment of Revenue
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-A~:= sooK1~8 PACEz~~v
Not valid without seal affixed .