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FORM OR- ~02
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STATE OF FI.ORIDA
DEPARTMENT ~F REVENUE
ESTATE TAX BUREAU
~ y' TALLAHASSEE. FLORIDA 32304
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EO STRAUGNN NON • TAXABLE CERTIFICATE AND RECEIPT
ExECU7ryE U~MECTOR FpR ESTATE TAX
TO: Olga M. Shiffler, Spouse
c/o Mr . Charles R. P. Brown ~ PP
Attorney atLaw ?
P. O. Box 1418 Re : The Estate of Edward D. Shi f f le r
Ft. Pierce, Florida 33450
Deceased.
Resident of st T•~~~~ P
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County, ~'lerida
Date' 1Q7Z
$5. 00 ~~~~~X` ee Received :~i~y 26. 1972
THIS IS TO CEBTIFY, That in accordance with the proviaions of Chapter 198,
Florida Statutes, there has been filed with this office.a sworn report or return for Estate ;
Taxes as required by taw and on the basis thereof it has been ascertained the above eatate
is not subject to the Florida Estate •Tax . The issuance of this certificate, however, shall
not preclude the assessment and collection of Estate Taxes subsequently determined to be
due the State of Florida.
If proof of non tiability~ by the above estate for the Florida Estate Tax is required
~ by any person this Certifieate may be exhibited as evidence of such non liability.
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(~iven in quadruplicate under my hand and the seal of the State of Florida the ~
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date first above written.
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Executtve Director
• _ ~ ~ Department of Revenue
Not valid without seal affixed .
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