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' • STATE OF FLORIDA
DEPARTMENT OF REVENUE
° ~ ESTATE TAX BUREAU
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~ TALLAHASSEE, FLORIOA 32304 ~r~o~~
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J FO STRwUGHN NON - TAXABLE CERTlFICATE AND RECEtPT
[aECU~~vE ~~atC~~~t
FOR ESTATE TAX
T°: C~07~_r~~
. Norma Scambler Spouse
c/o Mr. Gerald S. James, Atty.
P.O. Box 3089
Fort Pierce, FL 33450 The Estate of Floyd Scambler
Deceased.
Resident of st _ Luc; P
COU tity , F lori da
UBte : L2pCB s~r d* 1„97'~
$5. 00 $1: A~-Fee fteceived : samP
TH1S IS TO CERTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutes, there ha~ been ~led with 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 subjeci to the Florida F.atate Tax . The i~suance of this certificate, however, shall
nut pcectude the assessment and collection of F,state Taxes subsequently determined to be
due the State of Florida.
If prnof of non tiabitity b3• the above estate for the Florida Fstate Tax is required
by any person this Certificate msy be exhibited as evidence of such non liability. .
~=i~en in quadrupiicate under my hand and the seal of the State of I~'lorida the
date firyt atwve written.
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Fxer.utive Director
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` i • j' r ~ Department of Revenue
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N~t valid ~vithoui seal affixed . 2~o~z
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