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FORM DR• I02
STATE OF FI.ORIDA
DEPARTMENT OF REVENUE
ESTATE TAX BUREAU
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TALLAHASSEE, FLORIDA 32304 2S~~O~
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1. ED STRAUGMN NON -TAXABLE CERTIFICATE AND RECEIPT
«CNTIYE 01R[GTpR FOR ESTATE TAX
TO:Lucille Daciek Petitioaer
c/o Peninaular Title ~nsurance ~o. C 9 3 5 2 6
P.O. Box 3719
Fort Pierce, Florida 334S0
Re : The Estate of Joseph M. Daciek
Deceased. Fla. Prop. in St. Lucie?
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' Resident of Esaex ;
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County, New Jersey ~
Date : ~ An~ i o
$5.00 Fee Received : - sa~n?e
THIS IS TO C~RTIFY, Thet in accordance with the provi$ions of Chapter 198,
Fiorida Statutea, there has been filed with this office a sworn report or return for Estate
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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, however, shall ;
not preclude the asseasment and collection of Estate Taxes subsequently determined to be ~
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'j due the State of Florida. ~
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If proof of non liability by the above estate for the Fiorida Estate Tax is requited
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by any person this Certificate may be exhibited as evidence of such non liability.
Given in quadruplicate under my hand and the seal of the State of Florida the
date ~irst above written . ~
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i Not valld without seal effixed. 25 ~
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aooK 212 PA~ 2527 ;
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