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FOR~.f CR•102 ~ ~ ^
STATE OF FLORiDA
~ DEPARTh1ENT OF REVENUE 2'~Z~~`~
o ~c ESTATE TAX BUREAU
^ ~ TALLAHASSEE, FLORIDA 32304
,
J EO SfRAUGMN NON -TAXABLE CERTIFICATE AND RECEIPT
EiEW~~vE G~4ECtOA
FOR ESTATE TAX
TO: Kelsie Childers Spouse C 1 ~ 2 8~ ~
c/o Mr. Philip G. Nourse, Atty.
133-A North 4th St. -
Fort P~erce, FL 33450
Re: The Estate of Adam F. Childers
Deceased .
Resident of_ st. Luci _
C~ounty, Florida
Date: September 21, 1973
S5. 00 ~~~-~eQ R,~ceived : same
~ THIS [S TO CERTIF~', 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 !aw and on the basis thereof it has been ascertained the above estate
is not subject to the Ftorida F.state Tax . The issuance of this certifieate, however, _ shall
not preclude the assessment and collection of Estate Taxes subsequentty determined to be
due the State of Fiorida.
tf 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 liabitity.
(iiven in quadruplicate under my hand and the seal of the State of Florida the
;
date first above written . r«p a~t. kEC RB !
f~ lliC~E COyM~Y 1~~ g
ElERK
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_ R~COAO VERiFtEO ~ .
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- _ . . ~i A~ T~
' ~ Executive Director
= ' ' `2~'~~9v Department of R.evenue
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Not valid without ~eal affixed .
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