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iOF1M DR•30I
STATE OF FLORIDA
DEPARTMENT OF REVENUE
o~ t~ s ~ .
ESTATE TAX BUREAU _
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" ~ o TALLAHASSEE, FLORIDA 32304
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J ED57RAUGHN NON-TAXABLE CERTlFICATE AND RECEIPT
E~ECU~~VE O~RECTOI~ FOR ESTATE TAX
TO:Hazel H. Rollins Spouse
c/o Mr . Charles William Stone, Atty. A 17 011 PP
328 So. 2nd St. ~
' Fort Pierce, FL 33450 The Estate of Don A. Rollins
Deceased. Fla. prop. in St. Lucie Co.
i
E ~tesident of T.a Sa i i e
t
~ ,
! County, Tllinoia
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t
~ DAte' .Tdnna~~ ~ 1974
F
S
~ $ 5. 00 $~•-O~-Fee Received : jlpc`pmhPr 20 ~ 1973
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~ _ TNIS IS TO CERTIFY, 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
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~ Taxes as required by law and on the basis thereuf it has been ascertained the above estate
~ is not subject to the Floridal Estate Tax . The issuance of this certificate, however, shall
~ not preclude the assessment and collection of Estate Taxes subsequently determined to be
~ due the State of Florida.
~
~
tf proof of non liability by the above estate for the Florida Estate Tax is required
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by any person this Certificate may be exhibited as evidence of such non liability:
(~iven in quadruplicate under my hand and the seal of the State of Florida the
date first above written . ~ • -
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_ - . " '"M`• ~
- _ . , . . . Executive Uirector
~ • . Department of Revenue
FJ LED ~NO N~~ K
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\ RECOF.D ?'~f~~F"~ED _ .
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~ Not valid without seai affixed . 2~31~5
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