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SrATE O~' F~~LORIDA F~
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DEPARTME~VT OF FtEVENUE S1.lUCtE COUMTY F~ ~ '
<<,~ sw ROCE~ P01tRAS ,
o f ESTATE TAX 9Ui?EAU C~E4K ~.~:cu~T CouRT ~
TALLAHASSEE. F LORiDA 32":~4 1~E~OR^ yE4~fiE~ ~
` O N'73
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S,R~~~aNN NON-7AXABlE LERTiFlCATE AND REC~IP~ ~/r~)~~_II(~~-I(~ ~
C~L_Vr:rE G~w[:t01~ 2~,/L7W~
FOR ESTAT~ TAX
TO' ~na Aleredit?~ Exec~c. c ~ :
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c/o :=~r.ry R. Dutcher, ?~tt}?. s
65 Broad ~t.
R~chester, i~Y 19614 ~
Ke : The ~staic of ?+ai3cier N. ''ere~: i th ;
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i)ecessedFla, ~r~r?, in ~t. Lttcie & Lee !
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RKSiden:. of. -------;~;,:,=e co.
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OD Fee ~'i~ ceivec~ : -s~u•.e--- '
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THiS I~ 'i'Q ('ERTII~'1', That in arc~~r+lan,r x~th the nt7~ 1S1UIlS Of :.,hapter I~8 -
Florida Statutes, thece ha3 been filed with this ~ffire a swo*:~ r~p+,r~L or ret~r~ for Fstat~ -
Taxes as required by law and on :he basis thereof it ~~3s tren s~ecrtained tht~ abo~~e e~tafc ~
i is not subject to the Fbrida Estate Tax. The is.~uan~ e o~ ±hi9 crrtificate, how~Q~er, shal~ ;
; not preclude the assessment and cofiectiar: n~' Estdtp 'I'a~r~c ~ubsequentl~~ detzrmir.ec~ to bc
; due the State of Florida.
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; If proo~ uf no~ liabil'ity hy t~e a~ove estat~ for tnr Fior:da Fstate Tax is requirec
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` by any person this Certi~eate may be e~:liibitc~d a, evideace of ~uch. r.on i'sability. i
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~ (~iven in quadruplicate u~der my hand and the sea= of the ~tate of Florida the ~
` date first above writtpn. ~
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T:xecutive Dir~ctor
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Not valid without seal afFxed.
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