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fORM DR-~Ot j; i
STATE OF FLORIDA '
DEPARTMENT OF REVENUE
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° ESTATE TAX BUREAU ~
. TALLAHASSEE, FLORIDA 32304
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J EDSTRAUGNN NON-TAXABLE CERTIFICATE AND RECEIPT
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FOR ESTATE TAX
TO: ~
Morris Gamm Exec . ~ ~ S
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c/o Bryan & Koblegard~, Attys.
P.O. Box 3230
Ft. Pierce, FL 33450 Re: Tl~e Fstate of Moses James Robert
Deceas~•d. Fla . Prop . in St . Lucie Co .
Re~ident of
Ne~ Hayen
C~ntnty, - ~'onnect; ~-l~*
1)atr.: _ nP~Pmhor 21 . 19'73
~ 5.U0 I~ ce Hecei~-ecl.
THIS ~S TO CERTIFY, That in accordance with the provisions of Chapter 198,
Florida Statutea, there has been fled with this of~ce 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 eertificate, however, sha11
not preciude the assessment and collection of Estate Taxes subsequently determined to be -
due the State of Florida.
; If proof of non liability by the above estate for the Florida Estate Tax is 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 ~eal of the State of Florida the `
date first above written.
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,r: = a~ ' ~ _ Executive Director
' r , • Department of Revenue
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~ Not valid without sea! affixed . ~e~, 3/ I: 2 3 A. M
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