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ER FOItRA
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RECORO VtR(ii[D......~..~~
IN RE : Es tate of ~ ~ ~ ~ ~0 ~ ~~Z
ADRIAN M. SAMPLE,
deceased.
The West 30 feet of Lot 2, Block J, Tyler's Subdivision,
St. Lucie County, Florida.
FORM - 603 STATE OF FLORIDA ;
DEPARTMENT OF REVENUS y
, Certificate of Waiver and Release of Florida Estate Tax Lien
Estate of Resident at time of Death Date of Death
Adrian M. Sample Florida April 27, 1971
TO: Name and address of Applicant
St. Lucie County Bank
Trust Department
P. O. Box 8
Ft. Pierce, Florida 33450 ~ -
I, hereby certify that the estate tax for the above named estate, has
been duly discharged or duly provided for. Wherefore and by reason whereof,
I do hereby issue this certificate waiving and. releasing the lien of the
State of Florida imposed by Chapter 198, Florida Statutes, on the following
described property.
West 30 feet of Lot 2, Block J, Tyler's Subdivision, St. Lucie j
County, Florida.
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S' re Tit e: Chief Date ,
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R. Glenn Dixon 7-19-72 mer .
~ tate Tax Bureau
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