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FORM pR.302
' ~ STATE OF FLORIDA
DEPARTMENT OF REVENUE
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„ ESTATE TAX BUREAU ~
" ~ ~ TALLAHASSEE, FLORIDA 32304 `
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J. ED STRAUGMN NON -TAXABLE CERTIFICATE AND RECEIPT
E~ECU1iVE O~REC~OR
FOR ESTATE TAX
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•j.r~. :•i~rtt~_~• {;~er.zei; l:c~ti~cr
%~ii~ G<~r~::~n L~r~i:~E A ~6815 PP
La:;e Worr_,~, F~ ~c~i~ia 3~:•tE,~;
Re: The Estate of r;:,~- „~„?c~ j
o Deceased .
o~ R.esident of _ 4~ ~r~
~ County, = ~~~Z -
~ DBte: "`d• i~ I<.,".`
~ " . t,ia~~ I~ , l y7~
~ ~1.00 Fee Received: ;t<<-.~
$5.~~~~
~ THIS IS TO CEBTIFY, That in accordance w ith the provisions of Chapter 198,
Florida Statutes, there has been filed with this office a sworn report or return for Estate
Taxes as required by law and on the basis thereof it has been ascertai~ed the above estate
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' is not subject to the Florida Estate Tax . The issuance of this certificate, however, shall
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i not preclude the assessment and collection of Estate Taxes subsequently determined to be
~ due the State of Florida.
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~ " ~ If proof of non tiability by the above estate for the Florida Estate Tax is required
~ by any person this Certificate may be exhibited as evidence of such non liability.
(~iven in quadruplicate under my hand and the seal of the State of Florida the
~ date first above written .
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~ Executive Director
, t~ ~ r. Department of ftevenue
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~ Not vatid without seal affixed. 0~~~
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