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~ORM DR• ]02
STATE OF FLORI~A
DEPARTMENT OF REVENUE ~
S E ESTATE TAX BUREAU
TALLAHASSEE, FLORIDA 32304
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l ED STRAUGMN NON -TAXABLE CERTIFICATE AND RECEIPT
EtECUT.vE O~~ECipO FOR ESTATE TAX
TO: Harriett Leona Adams Treverton Spouse C 9 8 9 2 z
c/o Charles R. P. Brown, Atty.
P.O. Box 1418
Fort Pierce, FL 33450 The Estate of
' Carrol E. Adams
Deceased.
Resident of st_ Lucip
County, Florida
~ pgte; Jul~ 13~ 1973
;
$ 5. 00 ~
1-98-Fee Received : s ame
THIS IS TO CERTIFY, That in accordance with the provisions of Chapter 198,
~ Florida Statutes, there has been filed R ith this office a sworn report or return for Estate
~ 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, howe~~er, shall
~
not preclude the assessment and collection of Estate Taxes subsequentiy determir~ed to be
~
~ due the State of Florida.
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~ If proof of non liability by the above estate for the Fforida Estate Tax is required
by any person this Certificate may be exhibited as evidence of such non liability .
~ dru licate under m hand and the seal of the State of Florida the
~ G~ven ~n qua p y
~ date first above written .
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