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FORM OR- ~Ot
~ STATE OF FLORIDA ;
DEPARTMENT OF REVENUE 2~;O55~i
ESTATE TAX BUREAU
~ TALLAHASSEE. FI.ORlDA 32304
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, EO STRAUGMN NON • TAXABLE CERTIFICATE AND RECEIPT
E1lECYTwE O~R(CTOR
FOR ESTATE TAX
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TO: Betty Jean Ptacek Execx. C 9 9 8 41 '
c/o Philip G. Nourse, Atty.
133-A N. 4th St.
Fort Pierce, FL 33450 The Estate of :
' Florrie T. Richa~ds ;
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Deceased. '
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Resident of ~ st_ LuciQ _
County, Florida
Dgte • _ J~~ 30, 1973 ~
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55.00 $~:~88-Fee Received: same i
THIS IS TO GERTIFY, That in accordance with 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 hae been ascertained the above estate ~
is not subject to the F'lorida Estate Tax. The issuance of this certificate, however, shall ;
I not preclude the assessment and collection of Estate Taxes subsequently determined to be
due the State of Ftorida:
~ If proof of non liabi,~y the above estate for the Florida Estate Tax i9 required
~ by any person this Certificate may be exhibited as evidence of such non liability.
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- Given in quadruplicate under my hand and the seal of the State of Florida the
~ date first above written . -
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Not valid w~ithout seal affixed . ~
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